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LP-024 Colorectal duplication cyst with recto-vesica fistule in systemic lupus erythematosus patient
  1. Gede Perdana Putera,
  2. Deddy Nur Wachid Achadiono,
  3. Nyoman Kertiya and
  4. Ayu Paramaiswari
  1. Rheumatology, RSUP Dr. Sardjito, Indonesia


Description A 22 year old-female SLE patient with hematological, nephritis, mucocutaneous and arthritis manifestations presented with complaint of painful and enlarged of abdomen area since 2 weeks before admission. On the previous hospital, an ascites was suspected as the cause and a total of 1100cc reddish liquid was evacuated. No analysis or cytological examination of the fluid was carried out. Patient was then referred to Sardjito Hospital. Patient also had pancytopenia problems related to her SLE. Moderate normocytic anemia (Hemoglobin: 8.3 g/dL), leukopenia (AL: 2.3x103/uL), and severe thrombocytopenia (AT: 12,000/uL) were revealed. An abdominal ultrasound was performed and found a complex cyst in the right parametrium with thick septations and a solid component with mural nodules leading to a picture of malignancy. Examination of Ca-125 showed an increased result = 42 U/mL, CEA examination showed normal results = 3.58 ng/mL. A multisliced abdominal CT-scan was conducted and revealed a colorectal duplication cyst accompanied by a duplication cyst fistula at the level of the rectum with the urinary bladder. Grade 2 right hydronephrosis and hydroureter, hepatomegaly, and bilateral pleural effusion were also revealed. During treatment, there began to be a change in the patient‘s urine where feces material started to appear. A multidiscipline surgery procedure for the duplication cyst and fistule complication was planned. Despite adequate treatments of intravenous crystalloid, norepinephrine, Meropenem, PRC and platelet transfusions, patient died due to urosepsis shock before surgery could be carried out.

Conclusions Gastrointestinal tract duplication is a rare congenital anomaly that can form anywhere along the gastrointestinal tract. Its occurrence in SLE patients makes its cases increasingly rare. This case was reported because of problems in making a diagnosis due to the rare incidence causing a lack of suspicion towards the diagnosis, as well as symptoms and investigations that resemble other diseases.

  • SLE
  • duplication cyst
  • recto-vesica fistule

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