Perforation of Jejunal Diverticula in Steroids and Non-steroidal Anti-inflammatory Drug Abusers

Excerpt

Epidemiological and animal studies have shown that heavy use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastric and, to a lesser degree, duodenal ulcerations [1]. Several mechanisms have been proposed: direct mechanical irritation of the mucosa by the undissolved tablet, absorption in the stomach of the non-ionized salicylate, or inhibition of protective prostaglandins [2]. To perforate the gastrointestinal tract, erosion of the full thickness of the wall is required. In the case of diverticula, as the mucosa is prolapsed through the muscle layer of the gut, mucosal erosion alone is sufficient to result in perforation. Another theoretically possible mechanism is entrapment of the drug within the diverticulum, which may prolong its local action on the mucosa. …