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Seven Surgical Cases

Michael E. Kelly, MD; Lisa E. McMahon, MD; Dawn E. Jaroszewski, MD; Mahmoud M. Yousfi, MD; Giovanni De Petris, MD; James M. Swain, MD

Arch Surg. 2005;140:1162-1166.

Hypothesis  Small-bowel diaphragm disease is an important source of gastrointestinal tract bleeding and subacute intestinal obstruction that may require surgical intervention.

Design  Case series.

Setting  Tertiary-care academic medical center.

Patients  Seven consecutive patients with histologically confirmed enteropathy induced by use of nonsteroidal anti-inflammatory drugs received treatment at our institution from February 2001 to February 2004.

Interventions  Laparotomy with small-bowel resection.

Main Outcome Measures  Initial symptoms and signs, findings at diagnostic workup, type of medication and duration of use, operation performed, and intraoperative findings were evaluated.

Results  Patients were identified who had symptoms of subacute intestinal obstruction or signs of gastrointestinal tract bleeding and were determined to have used nonsteroidal anti-inflammatory drugs for differing periods. All 7 patients underwent extensive nondiagnostic radiologic and endoscopic examinations. The diagnosis of diaphragm disease was ultimately made at either video capsule endoscopy or laparotomy. Randomly distributed diaphragms throughout the jejunum and ileum necessitated resection in all cases. No patient has had a documented recurrence, although follow-up is short (range, 0-20 months).

Conclusions  Nonsteroidal anti-inflammatory drugs are clearly linked to pathologic findings of diaphragm disease in both the upper and lower gastrointestinal tracts. Although rarely reported in the surgical literature, small-bowel diaphragm disease may be more common than thought and can manifest as gastrointestinal tract bleeding or obstruction. Diagnosis is difficult and may require laparotomy and small-bowel resection.

Author Affiliations: Divisions of General Surgery (Drs Kelly, Jaroszewski, and Swain) and Gastroenterology and Hepatology (Dr Yousfi) and Departments of Otolaryngology Head and Neck Surgery/Audiology (Dr McMahon) and Pathology (Dr De Petris), Mayo Clinic, Scottsdale, Ariz.

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