Retained enteroscopy capsule in a patient with diaphragm disease

Abstract

INTRODUCTION Diaphragm disease is a rare consequence of small-bowel enteropathy, and usually occurs as a result of longstanding ingestion of non-steroidal anti-inflammatory drugs. DD is characterized by multiple strictures and saccular dilatations leading to symptoms of subacute intestinal obstruction. Often, the diagnosis is made on histological examination after laparotomy and resection of diseased small bowel. CASE HISTORY Here, we report a case of an elderly female who suffered for many years from chronic, colicky abdominal pain and anaemia due to undiagnosed diaphragm disease. Eventually, she was referred to our surgical team because of a retained enteroscopy capsule. The diagnosis was made after laparotomy and bowel resection. This surgical intervention alleviated chronic symptoms, and the patient remained well at 1-year follow-up. CONCLUSIONS This case highlights the difficulty of diagnosing diaphragm disease without laparotomy and bowel resection. A high index of suspicion must be exercised in any patient with chronic, colicky abdominal pain and anaemia together with multiple strictures and saccular dilatations on computed tomography even in the absence of longstanding NSAID ingestion. Moreover, capsule enteroscopy should be avoided as a diagnostic modality of small-bowel disease if computed tomography raises the suspicion of strictures.

Obscure Gastrointestinal Bleeding Due to Non-steroidal Anti-inflammatory Drug-Induced Colopathy

“…They are usually multiple superficials to deep ulcers with an irregular arrangement and <1 cm in diameter) [ 11 ]. CT and MRI are also helpful in diagnosing NSAID-induced small bowel diaphragms and strictures where the use of wireless-capsule enteroscopy is contraindicated [ 12 ].…”

Endoscopy Capsule Retention in a Young Female with Small Bowel Strictures Secondary to Non-Steroidal Anti-Inflammatory Drugs

“…Diagnosis of DD often requires endoscopy, gastrointestinal radiological techniques, and even laparotomy [ 1 , 4 ]. Chronic abdominal pain and anaemia are the 2 most common presenting features of SBDD with 58% and 42% frequency and rarely can cause obstruction [ 5 ]. The exact duration of NSAID uses to cause small bowel strictures is not clear.…”

Nonsteroidal anti-inflammatory drugs induced diaphragm disease: a report of 3 cases and literature review

“…If an obstruction is suspected, DBE might be a better option; this also has the advantage of allowing biopsies for histology. DBE is a valuable and minimally invasive technique for the detection of diaphragm disease, and endoscopic treatment is possible [ 10 ]. Despite these advances, a correct preoperative diagnosis is made at laparotomy in most cases.…”

“…Although not common, stricturoplasty may be an alternative choice for scattered lesions that are impossible to resect. Recently, with the development of DBE, endoscopic balloon dilation could be considered as an alternative option for diaphragm disease [ 10 ]. The risk of intestinal perforation with endoscopic balloon dilation would be low because of the fibrotic features of the diaphragm disease.…”