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Case report
Diaphragm disease of the terminal ileum presenting as acute small bowel obstruction
  1. Stephen Bennett1,
  2. Jack Martin1,
  3. Betania Mahler-Araujo2 and
  4. Stavros Gourgiotis1
  1. 1Cambridge Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Histopathology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Stephen Bennett; stevebennett{at}


Diaphragm disease (DD) of the small bowel is a rarely reported complication of non-steroidal anti-inflammatory drug (NSAID) use, characterised by diaphragm-like strictures, most commonly in the ileum, causing varying degrees of obstruction. It typically presents in the elderly, over many years with non-specific symptoms. Diagnosis is challenging, the majority of cases relying on histopathology for confirmation. Treatment involves NSAID cessation and surgery through a combination of stricturoplasties and/or segmental resection. Very rarely DD presents as a surgical emergency. A case presenting as acute small bowel obstruction (SBO) is described, initially diagnosed as adhesions, later confirmed to be DD of the terminal ileum following histopathological examination. Given the widespread use of NSAIDs and an ageing population, it is likely the incidence of DD will increase. It is, therefore, important that surgeons are aware of this disease entity and consider it as a potential diagnosis in patients presenting with acute SBO.

  • gastrointestinal surgery
  • rheumatoid arthritis
  • unwanted effects/adverse reactions
  • drugs: gastrointestinal system
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  • Contributors SG and JM were responsible for the surgical management of the case and review of the case report. BMA was responsible for the examination of the histology specimens and review of the case report. SB wrote the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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