title: Small bowel diaphragm disease mimicking malignancy.
abstract: Non-steroidal anti-inflammatory drugs (NSAIDs) can produce diaphragm disease where multiple strictures develop in the small bowel. This typically presents with anaemia and symptoms of small bowel obstruction. The strictures develop as a result of circumferential mucosal ulceration with subsequent contraction of rings of scar tissue. We report a case of a 47-year-old woman with a 6-month history of NSAIDs abuse who presented with subacute small bowel obstruction 1 year after stopping NSAIDs. CT and MRI showed multiple ileal strictures with florid locoregional lymphadenopathy. A malignant diagnosis such as lymphoma was considered likely as florid mesenteric lymphadenopathy has not been previously reported in diaphragm disease. Laparotomy with small bowel resection was therefore performed. Histology showed diaphragm disease with the enlarged mesenteric nodes having reactive features. Gross locoregional lymphadenopathy should not deter a diagnosis of diaphragm disease in cases of multiple small bowel strictures where there is a strong history of NSAIDs use.
authors.affiliation: Department of Surgery, Blackpool Victoria Hospital, Blackpool, UK.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Sarantitis
authors.affiliation: Department of Surgery, Blackpool Victoria Hospital, Blackpool, UK.
authors.forename: Adam Daniel
authors.initials: AD
authors.lastname: Gerrard
authors.affiliation: Department of Surgery, Blackpool Victoria Hospital, Blackpool, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Teasdale
authors.affiliation: Department of Surgery, Blackpool Victoria Hospital, Blackpool, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pettit
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000175:diagnosis; D003964:Diaphragm / Q000473:pathology*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000601:surgery*; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D007813:Laparotomy; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal