NSAIDs-induced diaphragm-like colonic strictures: a case report

Abstract

A 48-year-old woman presented with a 2-week history of diarrhoea and abdominal pain. No overt gastrointestinal bleeding was reported and there was no history of loss of weight or loss of appetite. General and abdominal examination was unremarkable except for subconjunctival pallor. The haemoglobin was 7.1 g/dl at presentation with the peripheral blood film indicating iron deficiency anaemia. An urgent colonoscopy revealed two strictures within a 5 cm segment of transverse colon. The distal stricture showed significant ulceration and inflammation, while the proximal one showed an impassable "diaphragm-like" stricture. Biopsies from both of the strictures showed chronic inflammatory infiltrate with numerous eosinophils and no evidence of malignancy. The patient had been taking enteric-coated diclofenac tablets 50 mg three times daily over the past 10 years for chronic backache. Her bowel symptoms resolved significantly within 4 weeks of stopping diclofenac and she continued to remain relatively asymptomatic at 3 months follow-up.

Iatrogenic pathology of the intestines

“…Although the first cases of diaphragm‐like lesions (lesions pathognomonic of NSAIDs) were described in the small intestine, similar lesions have also been noted in the colon, especially in patients taking sustained‐release preparations …”

“…Although the first cases of diaphragm-like lesions (lesions pathognomonic of NSAIDs) were described in the small intestine, 3,80 similar lesions have also been noted in the colon, 81,82 especially in patients taking sustained-release preparations. 75 These lesions consist of thin septal-like diaphragms, with or without well-circumscribed ulcers or superficial ulcerations at their margins, and with normal intervening mucosa.…”

Colonic Diaphragm in a Patient with Rheumatoid Arthritis – A Case Report from the Caribbean

“…It has been described more often occurring in the small intestine but it rarely occurs in the large bowel (5). Less than 50 cases of colonic diaphragm have been reported in the literature (6).…”

“…This method has been shown to be effective and has a low complication rate (20). To prevent further disease progression or recurrence it is also necessary to discontinue NSAID use (6). The non-specific colitis and colonic ulceration resolve on withdrawal of the NSAID therapy.…”

NSAID-induced diaphragmatic disease of the colon

“…Discontinuation of NSAIDs alone has been observed to be effective in resolving the inflammation underlying the colopathy; however, diaphragm disease itself is not reversed by this treatment strategy 3. Surgical resection of the affected segment of colon4 or endoscopic/fluoroscopic dilation of the diaphragms5 is the only option that provides satisfactory treatment of this condition.…”