Diaphragm disease associated with nonsteroidal anti-inflammatory drugs mimicking intestinal tumor: A case report. (2020)

• Record Type: Journal Article
• Authors: Mori, Aya; Hashida, Hiroki; Kitamura, Koji; Matsui, Jun; Mizuno, Ryosuke; Tanigawa, Yuma; Izumi, Ai; Ishida, Satoshi; Yamashita, Daisuke; Yamaguchi, Takako; Kaihara, Satoshi
• Is Part Of: International journal of surgery case reports. Volume 76(2020)
• Page Start: 121
• Page End: 124
• Publication Date: 2020
• Subjects: Diaphragm disease -- NSAIDs -- Ulcer -- Stenosis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.09.110
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Diaphragm disease is a rare NSAIDs-induced injury of the small intestine. Diaphragm disease is mostly surgically treated. Diagnosis with double-balloon enteroscopy can be considered for diaphragm disease. Abstract: Introduction: Diaphragm disease is rare and caused by intestinal obstruction due to nonsteroidal anti-inflammatory drugs (NSAIDs). Given the availability of video capsule endoscopy (VCE) and balloon enteroscopy (BE) this disease will be diagnosed more often. Presentation of case: A 73-year-old man was presented to our hospital for persistent nausea and vomiting. Abdominal ultrasound and computed tomography revealed small-bowel thickening, stricture in the terminal ileum, and dilation of the proximal small intestine. Differential diagnosis included ileal lymphoma and multiple ileal adenocarcinomas, and a diagnostic laparoscopy was performed. Twenty-centimeter of ileum was resected by primary ileo-ileal anastomosis. On pathological examination, fibrosis of the submucosa was identified, and erosions and numerous inflammatory cells reaching the submucosa were also identified from the specimen. Discussion: The preoperative diagnosis of diaphragm disease is sometimes challenging due to its uncharacteristic symptoms; moreover, radiological findings are usually indefinite and distinctive. Currently, the main treatment for diaphragm disease is surgery. Conclusion: We have documented a case of intestinal obstruction by NSAIDs. However, it is desirable to determine the course of treatment based on small bowel endoscopic dilatation cases in the future.