NSAIDs-induced diaphragm-like colonic strictures: a case report

Summary

A 48-year-old woman presented with a 2-week history of diarrhoea and abdominal pain. No overt gastrointestinal bleeding was reported and there was no history of loss of weight or loss of appetite. General and abdominal examination was unremarkable except for subconjunctival pallor. The haemoglobin was 7.1 g/dl at presentation with the peripheral blood film indicating iron deficiency anaemia. An urgent colonoscopy revealed two strictures within a 5 cm segment of transverse colon. The distal stricture showed significant ulceration and inflammation, while the proximal one showed an impassable “diaphragm-like” stricture. Biopsies from both of the strictures showed chronic inflammatory infiltrate with numerous eosinophils and no evidence of malignancy. The patient had been taking enteric-coated diclofenac tablets 50 mg three times daily over the past 10 years for chronic backache. Her bowel symptoms resolved significantly within 4 weeks of stopping diclofenac and she continued to remain relatively asymptomatic at 3 months follow-up.