Diaphragm disease and small bowel enteropathy due to nonsteroidal anti‐inflammatory drugs: a surgical perspective

Systematic review of small bowel diaphragm disease requiring surgery

“…3). As seen in our review, it can also rarely present acutely as a perforation or other form of acute abdomen [3,4,6,11,22].…”

“…A history of long‐term NSAID use in a patient presenting with small bowel obstruction should alert one to the possibility of diaphragm disease [3]. Laboratory tests commonly demonstrate non‐specific results such as a normocytic or microcytic anaemia or hypoalbuminaemia [3,4,6,8,21,23]. As is demonstrated by this review, the diagnosis tends to be made at the time of surgery (Fig.…”

“…As demonstrated in the review, it is widely accepted that the majority of these cases are still diagnosed at the time of laparotomy as the small bowel can be palpated although the diagnosis may still remain elusive (Fig. 4) [4,6,22].…”

“…Small bowel diaphragm disease was first described by Lang et al in 1988 and is a rare condition thought primarily to be caused by non-steroidal anti-inflammatory drug (NSAID) use [1][2][3][4]. NSAIDs are the most prescribed drugs in the world and, although efficacious, their effects on the small bowel are under-reported [5,6]. It is thought that 50-70% of patients on long-term NSAIDs develop an associated small bowel enteropathy [4,6,7].…”

Non-steroidal anti-inflammatory drug-induced colopathy

“…Biochemical levels are often unspecific, plain abdominal x-ray is not helpful and even CT-scans may not have the desired slice thickness to identify the colonic diaphragms 9. The diagnosis is most easily established with colonoscopy 6.…”