Rare cause of small bowel obstruction: diaphragm disease

Abstract

Diaphragm disease is a rare cause of small bowel obstruction, caused by circular fibrotic membranes resulting in a narrowed intestinal lumen. It is associated with prolonged non-steroidal anti-inflammatory drug use, and often requires surgical resection. We report the case of a man in his 50s presenting with recurrent anaemia and intermittent small bowel obstruction. Exploratory laparoscopy identified three distinct areas of congested, thickened and narrowed ileum. Symptoms resolved following small bowel resection. Histological examination found elongated mucosal folds with ulceration and submucosal fibrosis consistent with diaphragm disease. Common radiological findings include small bowel strictures and thickening, mucosal hyperenhancement, and small bowel dilatation. In this case, on retrospective review of the initial CT scan, it is possible to appreciate circumferential mural thickening correlating with the histological findings. This case highlights the importance of rigorous examination of CT imaging and the utility of exploratory laparoscopy in diagnosing diaphragm disease.

Keywords: Small intestine.

Figure 1

(A, B) Coronal CT images demonstrating dilated small bowel loops, with two areas of circumferential mural thickening in the ileum (arrows) consistent with mucosal diaphragms seen intra-operatively. (C) Axial CT image demonstrating the same area of circumferentially thickened ileum.