Ann Surg Treat Res.  2018 May;94(5):279-283. 10.4174/astr.2018.94.5.279.

Nonsteroidal anti-inflammatory drugs induced diaphragm disease: a report of 3 cases and literature review

• Yang CS
• Park JY
• Choi HR
• Kim D

• KMID: 2410273
• DOI: http://doi.org/10.4174/astr.2018.94.5.279

Abstract

Multiple strictures of small bowel induced by nonsteroidal anti-inflammatory drugs (NSAIDs), were known as diaphragm disease. The purpose of these case reports is to present 3 cases of diaphragm disease of small bowel and summarize the clinical features of this disease entity. A 34-year-old man, a 63-year-old man, and a 66-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstructions. Two of these patients had taken heavy NSAIDs use. Capsule endoscopy was performed in all cases and the all capsules were retained by circumferential strictures of the ileum. Segmental resection of the strictures was performed in 2 patients and 1 underwent just enterotomy and capsule removal. In conclusion, clinicians should be aware that diaphragm disease might be a cause of small bowel obstruction especially in patients receiving long term NSAIDs therapy.

Keyword

Nonsteroidal anti-inflammatory drug; Intestinal obstructions; Enteritis; Mucositis

MeSH Terms

Academic Medical Centers
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal
Capsule Endoscopy
Capsules
Constriction, Pathologic
Daegu
Diaphragm*
Enteritis
Female
Humans
Ileum
Intestinal Obstruction
Middle Aged
Mucositis
Anti-Inflammatory Agents, Non-Steroidal
Capsules

Figure

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  Fig. 1 (A) Double-balloon colonoscopy shows a diaphragm-like stricture in the ileum and the retained capsule. (B) The representative microscopic feature is submucosal fibrosis with insignificant inflammation and redundant submucosal tissues (circle) of septa-like structure (H&E, ×20).

• 

  Fig. 2 Capsule endoscopy shows a diaphragm-like stricture in the small bowel.

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  Fig. 3 (A) Abdominal CT scan showed thickening of bowel wall (white arrow) in the middle or distal segment of the ileum. (B) Longitudinal section of small bowel revealed multiple circumferential strictures with a pinhole opening. (C, D) The histologic evaluation shows multiple shallow ulcers with zonal fibrosis and chronic inflammation of submucosal connective tissues (H&E, ×20).

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