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Case Reports
. 2025 Jul 13;17(7):e87856.
doi: 10.7759/cureus.87856. eCollection 2025 Jul.

Small Intestinal Ulceration in Two Recurrence-Free Young Patients at 10 Years Postoperatively

Taiki Masuda  1   2 , Yasuko Aoyagi  1 , Sodai Arai  1 , Yu Nishiyama  1 , Mikito Inokuchi  1
Affiliations
Case Reports

Small Intestinal Ulceration in Two Recurrence-Free Young Patients at 10 Years Postoperatively

Taiki Masuda et al. Cureus. .

Abstract

Small intestinal ulcers are occasionally observed in daily medical practice, and although diagnostic abilities have improved in recent years and the disease pathogenesis has been elucidated, recurrence remains common, requiring proper therapeutic intervention. Herein, we report two cases of small intestine ulceration in young patients who did not experience recurrence for a long period of time after appropriate treatment at disease onset. Case 1 was of a 34-year-old woman who had been taking diclofenac sodium. She was diagnosed with intestinal obstruction through abdominal computed tomography (CT). The patient underwent partial resection of the obstructed ileum. Histopathological examination revealed fibrosis in the submucosa, leading to a diagnosis of stenosis secondary to drug-induced small intestinal ulceration caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Postoperatively, the NSAIDs were changed to a selective COX-2 inhibitor (celecoxib). Case 2 was of a 33-year-old man who underwent emergency surgery after an abdominal CT revealed free air. A perforation was found in the small intestine, and the area was resected. Histopathological examination revealed only nonspecific inflammatory findings, leading to a diagnosis of perforation due to a simple small intestinal ulcer. No recurrence was observed in 10 years in both cases. Thus, appropriate management of simple, nonmalignant small intestinal ulcers at initial presentation could be the only treatment needed, with long postoperative recurrence-free periods. These cases demonstrated that proper management of simple, nonmalignant small intestinal ulcers at the initial presentation can be the only treatment needed for long postoperative recurrence-free periods. With an aging society and improved diagnostic capabilities, small intestinal ulcers may become more common in the future. Therefore, the possibility of small intestinal ulceration should be considered when diagnosing ulcerative lesions of the gastrointestinal tract, such as acute abdomen.

Keywords: abdominal computed tomography; fibrosis; intestinal obstruction; small intestine; stenosis; ulcers.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Caliber change (arrow) was revealed on enhanced abdominal computed tomography
Figure 2
Figure 2. Intraoperative findings: Indurations was detected (arrows) in the ileum 40 cm proximal from the Bauhin valve.
Figure 3
Figure 3. Resected specimen (A) had strictures caused by linear ulcer (arrows), and histological findings (B) revealed submucosal fibrosis.
Figure 4
Figure 4. Abdominal computed tomography shows abdominal free air (arrow).
Figure 5
Figure 5. Intraoperative findings: perforation (arrow) in the jejunum 65 cm distal from Treitz ligament was found.
Figure 6
Figure 6. Resected specimen (A) had perforation in the opposite side of a mesentery, and histological findings (B) revealed only the nonspecific inflammation of small intestine.
See this image and copyright information in PMC

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