Diaphragm disease associated with nonsteroidal anti-inflammatory drugs mimicking intestinal tumor: A case report

Mori, Aya; Hashida, Hiroki; Kitamura, Koji; Matsui, Jun; Mizuno, Ryosuke; Tanigawa, Yuma; Izumi, Ai; Ishida, Satoshi; Yamashita, Daisuke; Yamaguchi, Takako; Kaihara, Satoshi

doi:10.1016/j.ijscr.2020.09.110

Cited by 4 publications

(6 citation statements)

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“…Small bowel diaphragm disease is a rare cause of small bowel obstruction that is often misdiagnosed due to the rarity of the condition and its presenting symptoms. The appearance of the small bowel lumen as concentric rings of fibrotic tissue defines the term "diaphragm" disease [ 1 , 2 ]. Stricturing of the small bowel is commonly seen in Crohn’s disease due to the recurrent episodes of inflammation and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for diaphragm disease of the small bowel include female gender, advanced age, and prolonged NSAID use, oftentimes in those with chronic back pain and arthritis [ 1 , 4 , 5 ]. Many have average use of NSAIDs for at least three to five years, though as little as two months of NSAID usage has been shown to cause these strictures [ 4 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many have average use of NSAIDs for at least three to five years, though as little as two months of NSAID usage has been shown to cause these strictures [ 4 , 6 ]. Of chronic NSAID users, it is suspected that about 2% will develop small bowel diaphragm disease [ 1 , 7 , 8 ]. Presenting symptoms include chronic abdominal pain, iron deficiency anemia, weight loss, and constipation.…”

Section: Discussionmentioning

confidence: 99%

“…Small bowel strictures were pathognomonic of Crohn’s disease until several decades ago when microscopic analysis of resected bowel facilitated the delineation of diaphragm disease. The effect of chronic NSAID use on the small bowel was first discovered histologically in 1988 [ 1 , 5 ]. Characteristic findings include thickening of the muscularis mucosa, fibrous change to the lamina propria, eosinophilic mucosa, and ulceration of the diaphragm [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…If the diagnosis is made early, surgery can sometimes be avoided, and patients can be treated with endoscopic balloon dilatation of the small bowel strictures, in addition to cessation of NSAID use [ 1 , 7 ]. When diagnostic laparoscopy is pursued, it can still fail to diagnose this disease as the external appearance of the small bowel may appear grossly normal due to the lack of transmural involvement [ 3 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Diaphragm Disease of the Small Bowel Presenting With Intussusception

Al-Feghali¹,

Sigley²,

Laird³

2021

Cureus

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Diaphragm disease of the small bowel is an uncommon condition with nonspecific symptoms, which causes strictures of the small bowel associated with non-steroidal anti-inflammatory drug (NSAID) use. Due to the nature of the disease process and the strictures it can form, patients often present with a clinical picture suggestive of small bowel obstruction, and the true diagnosis is not confirmed until histopathological examination. In this article, we present the case of a 73-year-old female with chronic NSAID use and gastrointestinal complaints who had undergone multiple endoscopic procedures which failed to identify the cause of her symptoms. Further investigation with video capsule endoscopy and CT enterography led to a diagnosis of intussusception believed to be caused by a small bowel mass. Retention of the video capsule endoscope prompted the decision to undertake diagnostic laparoscopy with push endoscopy and direct visualization of a string of small bowel strictures in the area of intussusception. This characteristic appearance of the bowel was then confirmed by pathology as diaphragm disease lesions. Diagnosis of this disorder is difficult due to its rarity and common symptoms that make other disease processes seem more probable. Early diagnosis can prompt counseling on cessation of NSAID use and interventions to decrease the risk of complications that may require surgical intervention. Physicians should be able to recognize diaphragm disease of the small bowel as a differential in patients presenting with obstructive bowel symptoms and even rare cases of intussusception in the setting of chronic NSAID use.

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Section: Discussionmentioning

confidence: 99%