Case Report
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World J Gastroenterol. Jun 21, 2011; 17(23): 2873-2876
Published online Jun 21, 2011. doi: 10.3748/wjg.v17.i23.2873
Diaphragm disease compared with cryptogenic multifocal ulcerous stenosing enteritis
Sook Hee Chung, Yunju Jo, Sang Ryol Ryu, Sang Bong Ahn, Byoung Kwan Son, Seong Hwan Kim, Young Sook Park, Young Ok Hong
Sook Hee Chung, Yunju Jo, Sang Ryol Ryu, Sang Bong Ahn, Byoung Kwan Son, Seong Hwan Kim, Young Sook Park, Department of Internal Medicine, Eulji University School of Medicine, Seoul 139-711, South Korea
Young Ok Hong, Department of Pathology, Eulji University School of Medicine, Seoul 139-711, Korea
Author contributions: Chung SH and Jo Y contributed equally to this work; Ryu SR, Ahn SB, Son BK, Kim SH and Park YS collected and reviewed the patient data; Hong YO analyzed the pathological data.
Correspondence to: Yunju Jo, MD, PhD, Associate Professor, Department of Internal Medicine, Eulji University School of Medicine, Eulji Hospital, 280-1 Hagye 1-dong, Nowon-gu, Seoul 139-711, South Korea. jyj1138@eulji.ac.kr
Telephone: +82-2-9708624 Fax: +82-2-9708621
Received: August 16, 2010
Revised: December 10, 2010
Accepted: December 17, 2010
Published online: June 21, 2011
Abstract

As the use of drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) increases, so too do gastrointestinal ulcers, bleeding, perforation and obstruction. Diaphragm disease of the small intestine is formed by submucosal fibrosis and destruction of lamina muscularis due to chronic ulceration, which corresponds to the most severe stage of NSAID enteropathy. It may lead to stricture of the small intestine. If such ulcerations and strictures in the small intestine are multiple, differential diagnosis is between diaphragm disease and cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), because the gross findings of diaphragm disease are similar to those of CMUSE. We report a rare case of diaphragm disease caused by NSAID. It has been finally confirmed by capsule endoscopy and the origin of chronic obscure gastrointestinal bleeding was found to be multiple ulcers and strictures in the small intestine. After operation, we diagnosed the patient with diaphragm disease rather than CMUSE.

Keywords: Non-steroidal anti-inflammatory agents, Enteritis, Gastrointestinal hemorrhage, Small intestine, Capsule endoscopy