Small Intestinal Stricture Caused by Non Steroidal Anti Inflammatory Drugs: Report of Two Cases

Takatoshi Matsuyama, Tetsunori Yoshimura, Tetsuro Higuchi, Hirotoshi Kobayashi, Toshiaki Ishikawa, Satoru Iida, Hiroyuki Uetake, Masamichi Yasuno, Masayuki Enomoto and Kenichi Sugihara

Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School

We report two cases of NSAIDs-induced bowel stricture. Case 1: A 74 year-old woman with a 5-year treatment history for arthritis taking Non Steroidal Anti Inflammatory Drugs (NSAIDs) and admitted for recurrence of tarry stool and anemia was found in endoscopic examination of the small intestine to have an ulcer of the small intestine. Despite medical management with an anti ulcer drug, she gradually developed a small intestinal obstruction 10 months later. Laparotomy and intraoperative enteroscopy of the small intestine, we found two lesions in the small intestine necessitating two partial intestine resections were performed. Case 2: An 82-year-old man with a long history of cardiac infarction treatment taking NSAIDs and who presented with hypo proteinemia and anemia was found in small intestinal contrast X-ray study to have multiple stricture of the ileum necessitating partial intestine resection by laparoscopy. This NSAIDs-induced bowel stricture is described as a "diaphragm disease" in the literature. Most lesions are multiple and located in the small bowel. A complete medication history is thus required from patients with idiopathic small and large bowel stricture.

Key words
diaphragm disease, non-steroidal anti-inflammatory drug, small intestine

Reprint requests
Takatoshi Matsuyama Department of Surgical Oncology, Tokyo Medical and Dental University Graduate School
1-5-45 Yushima, Bunkyo-ku, 113-8519 JAPAN

Accepted
February 20, 2008

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