TY  - JOUR
T1  - Small-bowel diaphragm disease: Seven surgical cases
AU  - Kelly ME, McMahon LE, Jaroszewski DE, Yousfi MM, De Petris G, Swain JM
Y1  - 2005/12/01
N1  - 10.1001/archsurg.140.12.1162
JO  - Archives of Surgery
SP  - 1162
EP  - 1166
VL  - 140
IS  - 12
N2  - 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.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.140.12.1162
UR  - http://dx.doi.org/10.1001/archsurg.140.12.1162
ER  -