Systematic review of small bowel diaphragm disease requiring surgery

Abstract

Small bowel diaphragm disease presenting as a surgical emergency is likely to become more common due to the increased use of NSAIDs. A history of NSAID use in patients with iron deficiency anaemia or obstructive symptoms should lead to a high index of suspicion for this condition and should be preoperatively investigated.

Retained enteroscopy capsule in a patient with diaphragm disease

“…Multiplicity of ulcers and strictures hinders differentiation between DD and cryptogenic multifocal ulcerous stenosing enteritis. 1 Ingestion of NSAIDs is implicated in 58% of affected patients so many cases are classified as 'idiopathic'.…”

“…Eventually, most DD patients require resection of the small bowel alone, resection plus strictureplasty, strictureplasty alone, or limited ileocaecal resection. 1,3,4 Our patient highlights the difficulty of diagnosing smallbowel DD 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 CT even in the absence of longstanding NSAID ingestion.…”

“…DD is also an important cause of bleeding in the gastrointestinal tract and subacute intestinal obstruction that may eventually necessitate surgical intervention. [1][2][3] In general, imaging investigations are inaccurate for the diagnosis of DD or for the differential diagnosis (tumours, ileocaecal tuberculosis, stricturing Crohn's disease). Nevertheless, imaging investigations continue to play an important part in the diagnosis of diseases within the small intestine.…”

“…The most common cause of DD is chronic ingestion of non-steroidal anti-inflammatory drugs (NSAIDs). 1 Often, the diagnosis of DD is delayed. Usually, DD is suspected during laparotomy, but confirmation is by histopathological examination of resected diseased small bowel.…”

“…It is also believed that chronic use of NSAIDs in the presence of factors that interfere with NSAID metabolism may be associated with intestinal injury with subsequent development of DD. 1,2 The site affected most commonly is the ileum (67%), followed by the jejunum. 2 Often, the symptoms of DD are non-specific.…”