Non-Steroidal Anti-Inflammatory drug (NSAID) Induced Diaphragm Disease: A Rare Cause of Small Bowel Obstruction – Case Report and Literature Review.
EAES Academy. Salama M. 07/05/22; 362988; P031
Mr. Mohamed Salama
Contributions
Contributions
Abstract
Introduction:
NSAIDs are the most commonly prescribed drugs worldwide and they are known to be associated with upper GI complications. However, NSAID-induced small bowel stricture known as diaphragm disease was first described by Long Et Al in 1988. Its diagnosis is challenging. We present a rare case of a 50 year old male who after an extensive diagnostic workup and small bowel resection for obstructive symptoms, was finally diagnosed with NSAID-induced diaphragm disease as confirmed by histology.
Case report:
A 50 year old male presented with intermittent epigastric pain, vomiting and abdominal distension for 2 years. He has a background history of type 2 Diabetes Mellitus, hyperlipidaemia, total hip replacement, post-traumatic chronic shoulder & cervical spine pain, and chronic anaemia. His medications include anti-diabetics and NSAIDs. He had a normal OGD and colonoscopy previously and capsule endoscopy 2 weeks before reported enteritis with concentric ulceration and strictures. CT on this admission reported multiple dilated loops of small bowel with transitional point in the terminal ileum - query internal hernia and adhesions.
He underwent laparoscopy which showed small bowel dilatation with a transition point in the ileum caused by multiple strictures in one segment. This segment was resected with primary anastomosis. No other small bowel pathology was identified intra-operatively. Histology reported ulceration and fibrosis in keeping with diaphragm disease with no evidence of Crohn’s or vasculitis. He made a good recovery and was advised to discontinue NSAIDs. He was still well at clinic a few months later.
Conclusions:
As surgeons frequently deal with small bowel obstruction, it is important to consider NSAID-induced enteropathy. The diagnosis is challenging as symptoms are often nonspecific and radiological studies remain inconclusive. Surgical resection is curative provided NSAIDs are discontinued. Drugs that could prevent or treat NSAID-induced enteropathy have not been developed. Follow up of these cases is needed as recurrence rate is up to 50% due to failure to appreciate the extent of lesions at the initial operation or due to continued use of NSAIDs.
NSAIDs are the most commonly prescribed drugs worldwide and they are known to be associated with upper GI complications. However, NSAID-induced small bowel stricture known as diaphragm disease was first described by Long Et Al in 1988. Its diagnosis is challenging. We present a rare case of a 50 year old male who after an extensive diagnostic workup and small bowel resection for obstructive symptoms, was finally diagnosed with NSAID-induced diaphragm disease as confirmed by histology.
Case report:
A 50 year old male presented with intermittent epigastric pain, vomiting and abdominal distension for 2 years. He has a background history of type 2 Diabetes Mellitus, hyperlipidaemia, total hip replacement, post-traumatic chronic shoulder & cervical spine pain, and chronic anaemia. His medications include anti-diabetics and NSAIDs. He had a normal OGD and colonoscopy previously and capsule endoscopy 2 weeks before reported enteritis with concentric ulceration and strictures. CT on this admission reported multiple dilated loops of small bowel with transitional point in the terminal ileum - query internal hernia and adhesions.
He underwent laparoscopy which showed small bowel dilatation with a transition point in the ileum caused by multiple strictures in one segment. This segment was resected with primary anastomosis. No other small bowel pathology was identified intra-operatively. Histology reported ulceration and fibrosis in keeping with diaphragm disease with no evidence of Crohn’s or vasculitis. He made a good recovery and was advised to discontinue NSAIDs. He was still well at clinic a few months later.
Conclusions:
As surgeons frequently deal with small bowel obstruction, it is important to consider NSAID-induced enteropathy. The diagnosis is challenging as symptoms are often nonspecific and radiological studies remain inconclusive. Surgical resection is curative provided NSAIDs are discontinued. Drugs that could prevent or treat NSAID-induced enteropathy have not been developed. Follow up of these cases is needed as recurrence rate is up to 50% due to failure to appreciate the extent of lesions at the initial operation or due to continued use of NSAIDs.
Introduction:
NSAIDs are the most commonly prescribed drugs worldwide and they are known to be associated with upper GI complications. However, NSAID-induced small bowel stricture known as diaphragm disease was first described by Long Et Al in 1988. Its diagnosis is challenging. We present a rare case of a 50 year old male who after an extensive diagnostic workup and small bowel resection for obstructive symptoms, was finally diagnosed with NSAID-induced diaphragm disease as confirmed by histology.
Case report:
A 50 year old male presented with intermittent epigastric pain, vomiting and abdominal distension for 2 years. He has a background history of type 2 Diabetes Mellitus, hyperlipidaemia, total hip replacement, post-traumatic chronic shoulder & cervical spine pain, and chronic anaemia. His medications include anti-diabetics and NSAIDs. He had a normal OGD and colonoscopy previously and capsule endoscopy 2 weeks before reported enteritis with concentric ulceration and strictures. CT on this admission reported multiple dilated loops of small bowel with transitional point in the terminal ileum - query internal hernia and adhesions.
He underwent laparoscopy which showed small bowel dilatation with a transition point in the ileum caused by multiple strictures in one segment. This segment was resected with primary anastomosis. No other small bowel pathology was identified intra-operatively. Histology reported ulceration and fibrosis in keeping with diaphragm disease with no evidence of Crohn’s or vasculitis. He made a good recovery and was advised to discontinue NSAIDs. He was still well at clinic a few months later.
Conclusions:
As surgeons frequently deal with small bowel obstruction, it is important to consider NSAID-induced enteropathy. The diagnosis is challenging as symptoms are often nonspecific and radiological studies remain inconclusive. Surgical resection is curative provided NSAIDs are discontinued. Drugs that could prevent or treat NSAID-induced enteropathy have not been developed. Follow up of these cases is needed as recurrence rate is up to 50% due to failure to appreciate the extent of lesions at the initial operation or due to continued use of NSAIDs.
NSAIDs are the most commonly prescribed drugs worldwide and they are known to be associated with upper GI complications. However, NSAID-induced small bowel stricture known as diaphragm disease was first described by Long Et Al in 1988. Its diagnosis is challenging. We present a rare case of a 50 year old male who after an extensive diagnostic workup and small bowel resection for obstructive symptoms, was finally diagnosed with NSAID-induced diaphragm disease as confirmed by histology.
Case report:
A 50 year old male presented with intermittent epigastric pain, vomiting and abdominal distension for 2 years. He has a background history of type 2 Diabetes Mellitus, hyperlipidaemia, total hip replacement, post-traumatic chronic shoulder & cervical spine pain, and chronic anaemia. His medications include anti-diabetics and NSAIDs. He had a normal OGD and colonoscopy previously and capsule endoscopy 2 weeks before reported enteritis with concentric ulceration and strictures. CT on this admission reported multiple dilated loops of small bowel with transitional point in the terminal ileum - query internal hernia and adhesions.
He underwent laparoscopy which showed small bowel dilatation with a transition point in the ileum caused by multiple strictures in one segment. This segment was resected with primary anastomosis. No other small bowel pathology was identified intra-operatively. Histology reported ulceration and fibrosis in keeping with diaphragm disease with no evidence of Crohn’s or vasculitis. He made a good recovery and was advised to discontinue NSAIDs. He was still well at clinic a few months later.
Conclusions:
As surgeons frequently deal with small bowel obstruction, it is important to consider NSAID-induced enteropathy. The diagnosis is challenging as symptoms are often nonspecific and radiological studies remain inconclusive. Surgical resection is curative provided NSAIDs are discontinued. Drugs that could prevent or treat NSAID-induced enteropathy have not been developed. Follow up of these cases is needed as recurrence rate is up to 50% due to failure to appreciate the extent of lesions at the initial operation or due to continued use of NSAIDs.
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