title: Diaphragm disease: the limitation of laparoscopy and assessment of the small bowel for strictures using a ball bearing.
abstract: Diaphragm disease is a rare cause of intestinal obstruction that will be seen with increasing frequency with the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs). We present a case study of a patient with diaphragm disease where the diagnosis was not apparent at laparoscopy, and passage of a steel ball through the small intestine was required to identify all strictures present. A high index of suspicion, recognition of the limitations of conventional diagnostic aids, and the need to assess the full length of the small bowel are all important in the surgical management of this condition.
authors.affiliation: Department of General Surgery, Salisbury District Hospital, Wiltshire SP2 8BJ, UK. catherine.moffat@salisbury.nhs.uk
authors.forename: C E
authors.initials: CE
authors.lastname: Moffat
authors.forename: M K
authors.initials: MK
authors.lastname: Khyan
authors.forename: C G
authors.initials: CG
authors.lastname: Davies
authors.forename: A S K
authors.initials: AS
authors.lastname: Ghauri
authors.forename: C J
authors.initials: CJ
authors.lastname: Ranaboldo
mesh_terms: D003964:Diaphragm / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy; D008875:Middle Aged