Unusual case of recurrent intestinal obstruction

Abstract

Intestinal diaphragm disease is a very rare entity and is generally recurrent subacute intestinal obstruction. A 38-year-old male admitted to hospital with subacute intestinal obstruction. The patient had a history of long-term nonsteroidal anti-inflammatory drugs (NSAIDs) intake. On computed tomography scan, no pathology found except for dilated bowel loops. He underwent diagnostic laparoscopy which showed stricture along distal jejunum with proximal dilated gut loops with collapsed distal gut loops, found unusual thin intraluminal diaphragm with pinpoint 3 mm opening along with it there was one more diaphragm 2 cm distal to it with 2 mm pinpoint opening, resection of both the stricturous part was done, and end-to-end jejunojejunostomy was done. Here on, histopath grossly received a segment of the intestine in two pieces along with fibrofatty tissue. Cut-open specimen showed narrowing of the lumen and at one place is marked band-like constriction. Microscopic appearance shows ulcerations of lining epithelium. The submucosa shows fibrosis along with the proliferation of the muscle fiber, neural, and vascular elements giving impression consistent with the jejunal diaphragm. Here, we report an unusual case of intestinal diaphragm disease in relation to the use of NSAIDs. The aim is to sensitize the medical officers regarding the rational use of NSAIDs.

Keywords

• intestinal diaphragm
• intestinal obstruction
• laparoscopy
• nonsteroidal anti-inflammatory drugs