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 disease ¹:

• oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) (major risk factor) or potassium chloride

• surgical anastomosis

• radiation

• intestinal ischaemia

• Crohn disease

• tuberculosis

• eosinophilic enteritis

Clinical presentation

The majority of patients are asymptomatic until demonstrating signs of intestinal obstruction. Symptoms include abdominal pain, distension, nausea, vomiting and inability to pass flatus. Additional clinical features 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 include ²:

• multiple strictures appearing as focal areas of stenosis and associated bowel wall thickening (more commonly ileal involvement compared to jejunal involvement)

• mucosal hyperenhancement (representing likely ulceration)

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

Treatment and prognosis

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

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