Diaphragm Disease of the Small Bowel: A Retrospective Review of CT Findings

Flicek, Kristina T.; Hara, Amy K.; Petris, Giovanni De; Yadav, Anitha; Johnson, C. Daniel

doi:10.2214/ajr.13.10732

Cited by 33 publications

(27 citation statements)

References 19 publications

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“…Areas of inflammation can then hemorrhage, form granulation tissue, and eventually result in weblike mucosal strictures. NSAIDinduced enteropathy results in thin (usually less than 3 mm) circumferential rings of mucosa that cause focal strictures referred to as mucosal diaphragms (27)(28)(29).…”

Section: Mucosal Diaphragmsmentioning

confidence: 99%

“…There is a focal intraluminal web or stricture at the site of the diaphragm that can lead to marked luminal narrowing. The bowel in the immediate proximal and distal segments may be normal in caliber ( Fig 6) (27,29), or there may be upstream dilatation in the setting of obstruction. Thus, in a patient with longterm NSAID use and unexplained small bowel obstruction, mucosal diaphragms should be considered in the differential diagnosis.…”

Section: Mucosal Diaphragmsmentioning

confidence: 99%

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Imaging of Drug-induced Complications in the Gastrointestinal System

McGettigan¹,

Menias²,

Gao³

et al. 2016

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Drug-induced injury commonly affects the gastrointestinal and hepatobiliary systems because of the mechanisms of absorption and metabolism. In pill esophagitis, injury is frequently related to direct contact with the esophageal mucosa, resulting in small superficial ulcers in the mid esophagus. Nonsteroidal anti-inflammatory drugs can lead to gastrointestinal tract ulcers and small bowel mucosal diaphragms (thin weblike strictures). Injury to the pancreatic and hepatobiliary systems can manifest as pancreatitis, acute or chronic hepatitis, cholestasis, or steatosis and steatohepatitis (which may progress to cirrhosis). Various drugs may also insult the hepatic vasculature, resulting in Budd-Chiari and sinusoidal obstructive syndromes. Focal lesions such as hepatic adenomas may develop after use of oral contraceptives or anabolic steroids. Ultrasonography, computed tomography, and magnetic resonance imaging can aid in diagnosis of drug-induced injuries and often are necessary to exclude other causes.

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Section: Mucosal Diaphragmsmentioning

confidence: 99%

Section: Mucosal Diaphragmsmentioning

confidence: 99%

Imaging of Drug-induced Complications in the Gastrointestinal System

McGettigan¹,

Menias²,

Gao³

et al. 2016

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“…The most common presentations of diaphragm disease are abdominal pain and anaemia,2 but it can present with more acute severe symptoms such as vomiting and distension, such as in this case. On CT, the most common finding of this disease is with small bowel strictures 2…”

Section: Discussionmentioning

confidence: 85%

“…The pathology of diaphragmatic disease of the small bowel is well characterised and can be defined by its gross appearance—strictures in the bowel resemble a perforated diaphragm1 with multiple characteristic circumferential stenosing lesions2—however, for definitive diagnosis, specimens often need histopathological testing. Microscopic specimens show granulation changes within the villous,3 4 exaggerated plical folds (figure 2), as well as duplication and inflammatory infiltrate within the muscularis mucosa (figure 3), caused by chronic injury.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of an NSAID-induced diaphragmatic disease of the small intestine

2016

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A 74-year-old woman was referred to the surgical team from clinic, reporting of a 1-week history of vomiting and abdominal distension on a background of previous large bowel resection for a flare up of diverticulitis with a suspicion of diaphragm disease of the small intestine diagnosed at the same time. She was initially managed conservatively owing to the likely diagnosis of adhesion(s) leading to small bowel obstruction, but a CT of the abdomen a day later revealed a recurrence of diaphragmatic disease of the small bowel causing an obstruction, most likely due to chronic non-steroidal anti-inflammatory drug use. She was taken to theatre for an emergency laparotomy and small bowel resection due to previous resections, from which she made a good recovery; she was discharged from hospital 8 days later.

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“…This made surgery mandatory, as florid locoregional lymphadenopathy has not been previously described in diaphragm disease 6 11. There has been one previous report of diaphragm disease being misdiagnosed with malignancy, however, in this patient there was ongoing treatment for malignancy and imaging showed only minor mesenteric lymph node enlargement 12.…”

Section: Discussionmentioning

confidence: 86%

Small bowel diaphragm disease mimicking malignancy

et al. 2015

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Non-steroidal anti-inflammatory drugs (NSAIDs) can produce diaphragm disease where multiple strictures develop in the small bowel. This typically presents with anaemia and symptoms of small bowel obstruction. The strictures develop as a result of circumferential mucosal ulceration with subsequent contraction of rings of scar tissue. We report a case of a 47-year-old woman with a 6-month history of NSAIDs abuse who presented with subacute small bowel obstruction 1 year after stopping NSAIDs. CT and MRI showed multiple ileal strictures with florid locoregional lymphadenopathy. A malignant diagnosis such as lymphoma was considered likely as florid mesenteric lymphadenopathy has not been previously reported in diaphragm disease. Laparotomy with small bowel resection was therefore performed. Histology showed diaphragm disease with the enlarged mesenteric nodes having reactive features. Gross locoregional lymphadenopathy should not deter a diagnosis of diaphragm disease in cases of multiple small bowel strictures where there is a strong history of NSAIDs use.

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Diaphragm Disease of the Small Bowel: A Retrospective Review of CT Findings

Abstract: Small-bowel diaphragm disease should be considered in patients with a history of long-term use of nonsteroidal antiinflammatory drugs, chronic abdominal pain, and anemia who present with CT findings of short, symmetric ileal strictures and focal bowel wall thickening.

Cited by 33 publications

References 19 publications

Imaging of Drug-induced Complications in the Gastrointestinal System

Imaging of Drug-induced Complications in the Gastrointestinal System

Recurrence of an NSAID-induced diaphragmatic disease of the small intestine

Small bowel diaphragm disease mimicking malignancy

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