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Case Reports
. 2023 Nov:112:108966.
doi: 10.1016/j.ijscr.2023.108966. Epub 2023 Oct 24.

A rare presentation of idiopathic small bowel diaphragm disease - A case report

Rajesh R Ballal  1 , Talha Ahmed  2 , Divya Achutha Ail  3 , Sumith Marian Colaco  1
Affiliations
Case Reports

A rare presentation of idiopathic small bowel diaphragm disease - A case report

Rajesh R Ballal et al. Int J Surg Case Rep. 2023 Nov.

Abstract

Introduction: Diaphragm disease, typically associated with long-term non-steroidal anti-inflammatory drug (NSAID) use, manifests as diaphragm-like small bowel strictures, often resulting in bowel obstruction.

Case description: A 75-year-old male presented with features of recurrent subacute intestinal obstruction, later diagnosed with multiple small bowel strictures via CT imaging. Surgical intervention, including resection and anastomosis, was performed to alleviate the obstruction. Histopathological examination of the resected specimen confirmed diaphragm disease, challenging its traditional association with NSAID use.

Discussion: Diaphragm disease, characterized by mucosal and submucosal diaphragm-like strictures, is typically attributed to NSAID usage. However, this case underscores the possibility of diaphragm disease in the absence of NSAID exposure. Pathological findings supported the presence of diaphragm-like strictures, despite the patient's denial of NSAID use.

Conclusion: This case emphasizes the importance of considering diaphragm disease as a differential diagnosis in patients with intermittent bowel obstruction, even in the absence of NSAID history.

Keywords: Case report; Diaphragm disease; Intestinal obstruction; NSAIDs; Small intestine.

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Conflict of interest statement

Conflict of interest statement The authors have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
CECT Images showing presence of dilated small bowel loops with multiple strictures in the terminal jejunum and ileum suggestive of small bowel obstruction.
Fig. 2
Fig. 2
Intra-op image showing strictures in the distal jejunum and proximal ilium of the small bowel with clamps applied proximally and distally indicating level of resection.
Fig. 3
Fig. 3
Ulceration restricted to mucosa, increased fibrosis (green) and haphazardly arranged smooth muscle bundles (pink) in submucosa (Masson's trichrome stain, 40×). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
A) Concentric stricture site showing increased fibrosis of the submucosa and thickened muscularis mucosa (Hematoxylin and Eosin, 40×); B) Fibrosis highlighted by Masson's trichrome stain, 40×.
Fig. 5
Fig. 5
Photomicrography of stricture showing haphazardly arranged smooth muscle fibers and increased fibrosis of submucosa and lack of transmural inflammation (Hematoxylin and Eosin, 40×).
See this image and copyright information in PMC

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