Severe Lupus Enteritis in a Regional Hospital: An Uncommon Presentation of the Acute Surgical Abdomen.

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder, with gastrointestinal (GI) involvement in 20%-50% of cases. Mostly, symptoms are non-specific, but lupus enteritis is a rare acute manifestation occurring in less than 6% of patients with SLE. This infrequency often leads to a delayed diagnosis, resulting in significant morbidity and mortality. We present the case of a 40-year-old female with a 9-year history of SLE, who developed severe diffuse lupus enteritis and hypovolemic shock in a regional hospital located 400 km from a tertiary care centre. The patient exhibited abdominal distension, vomiting and acute kidney injury. A contrast-enhanced CT scan revealed circumferential bowel wall thickening and free fluid, consistent with lupus enteritis. Initial management focused on stabilisation through aggressive rehydration and monitoring while awaiting transfer to a tertiary facility. Corticosteroids and supportive care led to a gradual resolution of symptoms. This case is educational for rural surgeons, highlighting the importance of recognising and managing rare acute GI manifestations of collagen vascular diseases like SLE in resource-limited settings. Early diagnosis and transfer are crucial to reducing mortality, and this case demonstrates the need for high clinical suspicion and decisive damage control intervention if indicated.