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Case Reports
. 2015 Jul 14:2015:bcr2015210174.
doi: 10.1136/bcr-2015-210174.

Small bowel diaphragm disease mimicking malignancy

Ioannis Sarantitis  1 , Adam Daniel Gerrard  1 , Rebecca Teasdale  1 , Stephen Pettit  1
Affiliations
Case Reports

Small bowel diaphragm disease mimicking malignancy

Ioannis Sarantitis et al. BMJ Case Rep. .

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) can produce diaphragm disease where multiple strictures develop in the small bowel. This typically presents with anaemia and symptoms of small bowel obstruction. The strictures develop as a result of circumferential mucosal ulceration with subsequent contraction of rings of scar tissue. We report a case of a 47-year-old woman with a 6-month history of NSAIDs abuse who presented with subacute small bowel obstruction 1 year after stopping NSAIDs. CT and MRI showed multiple ileal strictures with florid locoregional lymphadenopathy. A malignant diagnosis such as lymphoma was considered likely as florid mesenteric lymphadenopathy has not been previously reported in diaphragm disease. Laparotomy with small bowel resection was therefore performed. Histology showed diaphragm disease with the enlarged mesenteric nodes having reactive features. Gross locoregional lymphadenopathy should not deter a diagnosis of diaphragm disease in cases of multiple small bowel strictures where there is a strong history of NSAIDs use.

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Figures

Figure 1
Figure 1
MRI showing ileal strictures (arrows).
Figure 2
Figure 2
CT scan showing ileal stricture (long arrow) with prestenotic dilation of the ileum (short arrow).
Figure 3
Figure 3
CT scan showing concentric thickening of a 5 cm segment of ileum (long arrow) with enlarged locoregional nodes (short arrows).
Figure 4
Figure 4
Operative photograph showing 3 ileal strictures indicated by haemostats.
Figure 5
Figure 5
Operative photograph showing a 7 cm×3.5 cm lymph node conglomerate in the ileal mesentery (arrows).
See this image and copyright information in PMC

References

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