Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2017; 5(2): 67-72
Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.67
Multiple perforations and fistula formation following corticosteroid administration: A case report
Jing-Ni He, Zhong Tian, Xu Yao, Hang-Yu Li, Yun Yu, Yuan Liu, Jin-Gang Liu
Jing-Ni He, Zhong Tian, Xu Yao, Yun Yu, Yuan Liu, Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang 110000, Liaoning Province, China
Hang-Yu Li, Jin-Gang Liu, Department of General Surgery, the 4th Hospital Affiliated to China Medical University, Shenyang 110000, Liaoning Province, China
Author contributions: He JN and Li HY designed the report; He JN, Yao X and Liu Y collected the patient’s clinical data; He JN, Yu Y and Liu JG collected the relevant literature; He JN and Tian Z analyzed the data and wrote the paper.
Institutional review board statement: The subject gave written informed consent to the study protocol, which was approved by the ethics committee of Shengjing Hospital.
Informed consent statement: This patient gave his written informed consent before this case report was written.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Zhong Tian, MD, Director, Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, 39 Huaxiang Road, Shenyang 110000, Liaoning Province, China.
Telephone: +86-24-9661531711 Fax: +86-24-9661531711
Received: March 20, 2016
Peer-review started: March 22, 2016
First decision: July 20, 2016
Revised: November 14, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: February 16, 2017

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small- and medium-sized-vessel vasculitis. The literature contains only a few reports of gastrointestinal perforation with this condition. We report a patient with EPGA treated with high-dose steroid who underwent emergency surgery for intestinal perforations. We performed a simple repair of the 11 perforations. Intestinal fistulas developed 8 d postoperatively; they healed well after 60 d of continuous washing and negative pressure suction. The clinical data of 14 additional patients with EGPA or Churg-Strauss syndrome complicated with gastrointestinal perforation, which were reported from 1996 to 2014, were also collected and compared. The formation of multiple perforations and fistulas following high dosage steroid administration can have a good outcome with appropriate management. Meticulous attention to abdominal symptoms and appropriate interventions can result in timely management. Corticosteroid administration remains a very important perioperative procedure for EPGA.

Keywords: Vasculitis, Eosinophilic granulomatosis with polyangiitis, Churg-Strauss syndrome, Gastrointestinal perforation, Surgery

Core tip: Eosinophilic granulomatosis with polyangiitis (EGPA) complicated with intestinal perforation is very rare. It needs urgent surgical intervention but hormone administration usually covers up the situation and delays the prognosis. We report a 43-year-old male diagnosed with EGPA by biopsy who experienced high-dose hormone administration, 11 intestinal perforations, postoperative intestinal fistula, and eventually recovered. This article aims to share the treatment course and experience.