Small bowel diaphragm disease

Small bowel diaphragm disease is a rare clinical entity involving diaphragm-like septa causing small bowel lumen narrowing.

Epidemiology

Small bowel diaphragm disease is a relatively rare disease, with limited reported literature on its incidence and prevalence ¹.

Risk factors

The following risk factors are thought to increase the likelihood of small bowel diaphragm disease¹

• oral medications such as NSAIDs or potassium chloride

• surgical anastomosis

• radiation

• intestinal ischaemia

• crohn's disease

• tuberculosis

• eosinophilic enteritis

Clinical presentation

The majority of patients are symptomatic until demonstrating signs of intestinal obstruction. Symptoms include abdominal pain, distension, nausea, vomiting and inability to pass flatus.

Additional symptoms the patient may demonstrate are signs of iron deficiency anaemia.

Radiographic features

Diagnosis is typically made on pathology, nevertheless, radiographical features may suggest a diagnosis.

CT

CT features include²

• multiple strictures appear as focal areas of stenosis and associated bowel wall thickening (commonly ileum involvement but can involve the jejunum)

• mucosal hyperenhancement (likely ulceration)

Importantly, small-bowel strictures may appear without significant small-bowel dilatation.

Treatment

Management is typically surgical, involving small bowel resection, combined resection and strictureplasty, or in rare cases involving strictureplasty and hemicolectomy ^{1, 3}

Long term management involves lifelong cessation of the offending agent i.e. NSAIDs.