Duodenal diaphragmlike stricture induced by acetylsalicylic acid

Blinder, G; Hautekèete, M.; Holvoet, J; Kockx, M.; Hubens, H

doi:10.1007/bf02093806

Cited by 16 publications

(9 citation statements)

References 11 publications

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“…The majority of the specimens were obtained because of retention of the video capsule, suggesting the difficult preoperative diagnosis of this condition. The gross and clinical features were typical and similar to those reported in the literature, [3][4][5][6][7][8][9][10][11][12][13][14][15]26,29 with the exception of the diagnosis being reached by video capsule endoscopy in 6 of our cases.…”

Section: Discussionsupporting

confidence: 86%

“…The importance of NSAID-related enteropathy has been emphasized recently, 2 but the histologic features of DD of the small intestine have been reported in only a limited number of cases. [3][4][5][6][7][8][9][10][11][12][13][14] The initial thorough description of DD by Lang et al 15 was followed by several others [16][17][18][19] that have revealed few additional findings. These additional findings have included villous atrophy, 16 association or overlap with socalled neuromuscular and vascular hamartoma (NMVH), 17 rare association with pseudoneoplastic lesions such as inflammatory fibroid polyp (IFP), 18 and, recently, an entity called NSAID-associated submucosal fibrous nodules of the small intestine.…”

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confidence: 99%

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Histopathology of Diaphragm Disease of the Small Intestine

Petris

López

2008

Am J Clin Pathol

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Diaphragm disease (DD) is an uncommon gastrointestinal abnormality typical of nonsteroidal anti-inflammatory drug (NSAID)-induced injury. DD of the small intestine is well defined in its gross appearance (multiple circumferential stenosing lesions); however, its histologic features have been studied in few cases. To better define and update the histologic features of DD, we describe 10 cases in which patients underwent resection of portions of small intestine for DD. Selected gross features and 12 microscopic features were assessed. The typical gross appearance of DD was associated with focal chronic injury of the mucosa with mild to moderate inflammatory infiltrate. A wide array of additional abnormalities was found: eosinophilic enteritis (3 cases), inflammatory fibroid polyp (1 case), enteritis cystica profunda (1 case), villous atrophy (1 case), and neuromuscular and vascular hamartoma-like changes (9 cases). DD and, therefore, NSAID-related injury, should be considered in the differential diagnosis of several conditions affecting the small intestine.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

Histopathology of Diaphragm Disease of the Small Intestine

Petris

López

2008

Am J Clin Pathol

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“…The likeliest cause for duodenal webs in adulthood is chronic use of non‐steroidal anti‐inflammatory drugs (NSAIDs) [3,4]. These drugs cause an inflammatory tissue reaction, submucosal fibrosis and finally diaphragm‐like strictures [4]. This was the most likely pathology in our case, as the patient was previously asymptomatic and congenital webs would have presented much earlier.…”

Section: Discussionmentioning

confidence: 90%

“…The patient described here developed symptoms only in her ninth decade. The likeliest cause for duodenal webs in adulthood is chronic use of non‐steroidal anti‐inflammatory drugs (NSAIDs) [3,4]. These drugs cause an inflammatory tissue reaction, submucosal fibrosis and finally diaphragm‐like strictures [4].…”

Section: Discussionmentioning

confidence: 99%

Duodenal webs – no age limit

Serracino‐Inglott

Smith

Anderson

2003

HPB

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BackgroundDuodenal webs usually give rise to symptoms of gastric outlet obstruction in infancy, but they occasionally present in adulthood. Case outlineWe report an 82-year-old woman with an unusual cause ofgastric outlet obstruction. Peptic ulcer stricture or carcinoma were suspected, but a CT scan and upper gastrointestinal endoscopy revealed that her symptoms were the result of duodenal webs.The webs were successfully dilated at endosocpy. DiscussionDuodenal webs may rarely account for gastric outlet obstruction in adults. Failure to visualise the second and third parts of the duodenum at endoscopy means that the diagnosis may be missed. Diclofenac and slow-release potassium tablets may have played an aetiological role in the formation of the webs in this patient.

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“…Several other authors also have reported observing, during endoscopic examination [12][13][14][15] or after laparotomy, [16][17][18][19][20][21] the presence of diaphragmlike lesions in the small or large intestine or both of patients taking NSAIDs. Huber et al 12 described a 61-year-old man, taking NSAIDs, who had iron deficiency anemia and obscure GI bleeding.…”

Section: Discussionmentioning

confidence: 93%

Diaphragm Disease After Use of Nonsteroidal Anti-inflammatory Agents

Yousfi¹,

Petris²,

Leighton³

et al. 2004

Journal of Clinical Gastroenterology

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Diaphragm disease of the small intestine is part of the spectrum of diseases associated with injury to the gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs. Standard endoscopy or contrast studies of the small intestine rarely identify these lesions. The diagnosis usually is established at the time of surgery. We report the case of a 72-year-old woman with obscure gastrointestinal bleeding and intermittent obstruction of the small intestine who had had multiple hospitalizations and extensive testing. The patient had been treated with nonsteroidal anti-inflammatory drugs for osteoarthritis. A radiograph of the small intestine with barium contrast revealed no abnormalities, so capsule endoscopy was performed. Capsule endoscopy showed multiple small intestinal strictures beyond which the capsule could not pass. After the patient experienced continued symptoms suggestive of intermittent partial obstruction of the small intestine, computed tomography showed the capsule within a dilated loop of intestine adjacent to a stricture. After 9 days of conservative medical therapy and worsening symptoms, the patient required an exploratory laparotomy. The capsule was located in a 12-cm segment of intestine with 4 diaphragm-like lesions. Pathologic study found submucosal lesions with features identical to those of neuromuscular and vascular hamartoma (eg, mature, reactive tissue elements of smooth muscle, dense fibrous tissue, and nerve tissue bundles with scattered ganglion cells and vessels). No manifestations of Crohn disease were evident. This case represents the first diagnosis with capsule endoscopy of diaphragm disease of the small intestine with pathologic features of neuromuscular and vascular hamartoma.

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Duodenal diaphragmlike stricture induced by acetylsalicylic acid

Cited by 16 publications

References 11 publications

Histopathology of Diaphragm Disease of the Small Intestine

Histopathology of Diaphragm Disease of the Small Intestine

Duodenal webs – no age limit

Diaphragm Disease After Use of Nonsteroidal Anti-inflammatory Agents

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