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Case Reports
. 2020:76:121-124.
doi: 10.1016/j.ijscr.2020.09.110. Epub 2020 Sep 19.

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

Aya Mori  1 , Hiroki Hashida  2 , Koji Kitamura  2 , Jun Matsui  2 , Ryosuke Mizuno  2 , Yuma Tanigawa  2 , Ai Izumi  2 , Satoshi Ishida  2 , Daisuke Yamashita  3 , Takako Yamaguchi  3 , Satoshi Kaihara  2
Affiliations
Case Reports

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

Aya Mori et al. Int J Surg Case Rep. 2020.

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.

Keywords: Diaphragm disease; NSAIDs; Stenosis; Ulcer.

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Figures

Fig. 1
Fig. 1
An abdominal ultrasound scan depicting the dilated small intestine with stagnant contents.
Fig. 2
Fig. 2
A CT scan showing small-bowel thickening and dilation of the proximal small intestine.
Fig. 3
Fig. 3
A resected specimen showing stenosis with wall thickening and ulcer (Allow indicates ulcer.).
Fig. 4
Fig. 4
Fibrosis of the submucosa and formation of lymphatic follicles in the submucosal and serous layers at the site of stenosis. In the ulcerated area, erosions and numerous inflammatory cells that reach the submucosa. (Allow indicates lymphatic follicles) (hematoxylin and eosin stain, ×1.25).
Fig. 5
Fig. 5
Apoptotic bodies in the crypts.
See this image and copyright information in PMC

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