Distal small bowel과 colon에 대한 NSAIDs 이상 반응 : intestinal diaphragms

Intestinal diaphragms

A lesion thought to be pathognomonic of NSAID injury is the diaphragm-like stricture, which is likely a scarring reaction secondary to ulcerative injury. These lesions are thin, concentric, diaphragm-like septa with pinhole-sized lumen. They are usually multiple, found mostly in the mid-intestine, but have also been described in the ileum and colon. They are histologically characterized by submucosal fibrosis with normal overlying epithelium, apart from tip of diaphragm, which may be ulcerated. The mucosa between diaphragms is normal. As a potential cause of subacute obstruction, these strictures are difficult to diagnose since they may appear as exaggerated plica circularis under radiographic imaging. At laparotomy, the surgeon should be alerted to this possibility, since the exterior aspect may look normal and the strictures difficult to palpate. In this regard, intraoperative enteroscopy is helpful.

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DBE NSAID induced stricture

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Proximal ileal nonsteroidal antiinflammatory drug (NSAID)-induced diaphragm-like stricture diagnosed by double balloon enteroscopy (DBE).

Courtesy of Louis-Michel Wong Kee Song, MD, FRCP(C).

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REF. UpToDate 2019.09.16