title: Small-bowel diaphragm disease: seven surgical cases.
abstract: OBJECTIVE
  Small-bowel diaphragm disease is an important source of gastrointestinal tract bleeding and subacute intestinal obstruction that may require surgical intervention.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary-care academic medical center.
  
  
  METHODS
  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.
  
  
  METHODS
  Laparotomy with small-bowel resection.
  
  
  METHODS
  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.
authors.affiliation: Division of General Surgery, Mayo Clinic, Scottsdale, Ariz 85259, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kelly
authors.forename: Lisa E
authors.initials: LE
authors.lastname: McMahon
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Jaroszewski
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Yousfi
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Petris
authors.forename: James M
authors.initials: JM
authors.lastname: Swain
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002214:Capsules; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000601:surgery; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery*; D007421:Intestine, Small; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014741:Video Recording / Q000295:instrumentation
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002214:Capsules