Diaphragm Disease After Use of Nonsteroidal Anti-inflammatory Agents
| Autor: | Nizar N. Ramzan, Mahmoud M. Yousfi, Giovanni De Petris, Barbara A. Pockaj, Dawn E. Jaroszewski, David E. Fleischer, Russell I. Heigh, Jonathan A. Leighton, Virender K. Sharma |
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| Rok vydání: | 2004 |
| Předmět: |
Pathology
medicine.medical_specialty Vascular Hamartoma Exploratory laparotomy Hamartoma medicine.medical_treatment Endoscopy Gastrointestinal law.invention Capsule endoscopy law Intestine Small medicine Humans Aged Gastrointestinal tract medicine.diagnostic_test business.industry Anti-Inflammatory Agents Non-Steroidal Gastroenterology Capsule Small intestine Endoscopy Diaphragm (structural system) Intestinal Diseases medicine.anatomical_structure Female business |
| Zdroj: | Journal of Clinical Gastroenterology. 38:686-691 |
| ISSN: | 0192-0790 |
| Popis: | Diaphragm disease of the small intestine is part of the spectrum of diseases associated with injury to the gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs. Standard endoscopy or contrast studies of the small intestine rarely identify these lesions. The diagnosis usually is established at the time of surgery. We report the case of a 72-year-old woman with obscure gastrointestinal bleeding and intermittent obstruction of the small intestine who had had multiple hospitalizations and extensive testing. The patient had been treated with nonsteroidal anti-inflammatory drugs for osteoarthritis. A radiograph of the small intestine with barium contrast revealed no abnormalities, so capsule endoscopy was performed. Capsule endoscopy showed multiple small intestinal strictures beyond which the capsule could not pass. After the patient experienced continued symptoms suggestive of intermittent partial obstruction of the small intestine, computed tomography showed the capsule within a dilated loop of intestine adjacent to a stricture. After 9 days of conservative medical therapy and worsening symptoms, the patient required an exploratory laparotomy. The capsule was located in a 12-cm segment of intestine with 4 diaphragm-like lesions. Pathologic study found submucosal lesions with features identical to those of neuromuscular and vascular hamartoma (eg, mature, reactive tissue elements of smooth muscle, dense fibrous tissue, and nerve tissue bundles with scattered ganglion cells and vessels). No manifestations of Crohn disease were evident. This case represents the first diagnosis with capsule endoscopy of diaphragm disease of the small intestine with pathologic features of neuromuscular and vascular hamartoma. |
| Databáze: | OpenAIRE |
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