Mori Aya, Hashida Hiroki, Kitamura Koji, Matsui Jun, Mizuno Ryosuke, Tanigawa Yuma, Izumi Ai, Ishida Satoshi, Yamashita Daisuke, Yamaguchi Takako, Kaihara Satoshi
Department of Surgery, Kobe City Medical Center General Hospital, Japan.
Department of Surgery, Kobe City Medical Center General Hospital, Japan.
Int J Surg Case Rep. 2020;76:121-124. doi: 10.1016/j.ijscr.2020.09.110. Epub 2020 Sep 19.
Diaphragm disease is rare and caused by intestinal obstruction due to nonsteroidal anti-inflammatory drugs (NSAIDs). Given the availability of video capsule endoscopy (VCE) and balloon enteroscopy (BE) this disease will be diagnosed more often.
A 73-year-old man was presented to our hospital for persistent nausea and vomiting. Abdominal ultrasound and computed tomography revealed small-bowel thickening, stricture in the terminal ileum, and dilation of the proximal small intestine. Differential diagnosis included ileal lymphoma and multiple ileal adenocarcinomas, and a diagnostic laparoscopy was performed. Twenty-centimeter of ileum was resected by primary ileo-ileal anastomosis. On pathological examination, fibrosis of the submucosa was identified, and erosions and numerous inflammatory cells reaching the submucosa were also identified from the specimen.
The preoperative diagnosis of diaphragm disease is sometimes challenging due to its uncharacteristic symptoms; moreover, radiological findings are usually indefinite and distinctive. Currently, the main treatment for diaphragm disease is surgery.
We have documented a case of intestinal obstruction by NSAIDs. However, it is desirable to determine the course of treatment based on small bowel endoscopic dilatation cases in the future.
膈膜病较为罕见，由非甾体类抗炎药（NSAIDs）导致肠梗阻引起。鉴于视频胶囊内镜检查（VCE）和气囊小肠镜检查（BE）的应用，这种疾病的诊断将会更加频繁。
一名73岁男性因持续性恶心和呕吐入住我院。腹部超声和计算机断层扫描显示小肠增厚、回肠末端狭窄以及近端小肠扩张。鉴别诊断包括回肠淋巴瘤和多发性回肠腺癌，并进行了诊断性腹腔镜检查。通过原发性回肠-回肠吻合术切除了20厘米的回肠。病理检查发现黏膜下层纤维化，标本中还发现了糜烂以及累及黏膜下层的大量炎性细胞。
膈膜病术前诊断有时具有挑战性，因其症状不典型；此外，影像学表现通常不明确且缺乏特异性。目前，膈膜病的主要治疗方法是手术。
我们记录了一例由NSAIDs引起的肠梗阻病例。然而，未来希望根据小肠内镜扩张病例来确定治疗方案。
