Kim YK, Jung HI, Kim H, Bae SH. Ischemic duodenal injury due to systemic lupus erythematosus: A case report. World J Gastroenterol 2026; 32(8): 115654 [DOI: 10.3748/wjg.v32.i8.115654]
Corresponding Author of This Article
Sang Ho Bae, MD, PhD, Professor, Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Cheonan 31151, South Korea. bestoperator@schmc.ac.kr
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Surgery
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Case Report
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Feb 28, 2026 (publication date) through Feb 14, 2026
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World Journal of Gastroenterology
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1007-9327
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Kim YK, Jung HI, Kim H, Bae SH. Ischemic duodenal injury due to systemic lupus erythematosus: A case report. World J Gastroenterol 2026; 32(8): 115654 [DOI: 10.3748/wjg.v32.i8.115654]
World J Gastroenterol. Feb 28, 2026; 32(8): 115654 Published online Feb 28, 2026. doi: 10.3748/wjg.v32.i8.115654
Ischemic duodenal injury due to systemic lupus erythematosus: A case report
Yung Kil Kim, Hae Il Jung, Hyeyoung Kim, Sang Ho Bae
Yung Kil Kim, Hae Il Jung, Hyeyoung Kim, Sang Ho Bae, Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, South Korea
Author contributions: Kim YK led data acquisition, case organization, figure preparation, literature review, and manuscript drafting; Bae SH oversaw surgical management, provided expert interpretation, and critically reviewed the manuscript; Jung HI contributed pathological evaluation and manuscript revision; Kim H contributed rheumatologic assessment, interpretation of clinical progression, and manuscript revision; all authors have read and approved the final version of the manuscript.
Informed consent statement: This case report was conducted in accordance with the institutional ethical standards and principles of the Declaration of Helsinki (revised in 2013). Written informed consent was obtained from the patient for the publication of the case details and accompanying images.
Conflict-of-interest statement: The Soonchunhyang University Research Fund provides a publication-support incentive that is awarded after acceptance of an article in an international journal. This incentive is a recognition award from the institution rather than research funding, and it is not related in any way to study design, data collection, analysis, or manuscript preparation. The authors declare no other conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised in accordance with these guidelines.
Corresponding author: Sang Ho Bae, MD, PhD, Professor, Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Cheonan 31151, South Korea. bestoperator@schmc.ac.kr
Received: October 22, 2025 Revised: December 11, 2025 Accepted: December 31, 2025 Published online: February 28, 2026 Processing time: 112 Days and 21.3 Hours
Abstract
BACKGROUND
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organ systems. Lupus enteritis is a rare but potentially life-threatening gastrointestinal manifestation characterized by immune complex-mediated inflammation that may cause edema, ischemia, or intestinal perforation. Because abdominal symptoms often overlap with those of infection or drug toxicity, an accurate diagnosis requires a high index of suspicion supported by characteristic radiologic findings.
CASE SUMMARY
A 47-year-old female with a known history of SLE and membranous glomerulonephritis presented with acute epigastric pain. Contrast-enhanced computed tomography revealed venous-type ischemia involving the second portion of the duodenum and proximal jejunum. Despite intensive medical management, progressive ischemic changes necessitated surgical resection and duodenojejunostomy. Postoperatively, the patient developed pancreatitis and biliary obstruction at the ampulla of Vater, requiring coordinated multidisciplinary care, including rheumatologic evaluation for disease flares, radiology-guided percutaneous transhepatic biliary drainage, internal stent placement, and pathological confirmation of small-vessel vasculitis. Both complications resolved after intervention. Duodenal involvement in lupus enteritis is exceptionally rare, and cases requiring surgical intervention are even rarer. Consequently, only a few cases have been reported.
CONCLUSION
Prompt recognition and multidisciplinary management are essential for favorable outcomes in patients with severe lupus enteritis and duodenal involvement.
Core Tip: Duodenal involvement in lupus enteritis is exceptionally rare and may progress to ischemia requiring surgery. Early recognition is critical, as delayed diagnosis can be life-threatening. Because it is often difficult to predict whether lupus enteritis will respond to steroids or instead progress to ischemia, a multidisciplinary approach and timely decision-making are essential. In this case, early duodenal resection and duodenojejunostomy prevented further deterioration, and postoperative biliary obstruction was successfully managed through intervention. This case highlights that in systemic lupus erythematosus patients with acute abdominal symptoms, lupus enteritis should be considered and coordinated management is crucial.
