Original Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 21, 2011; 17(31): 3596-3604
Published online Aug 21, 2011. doi: 10.3748/wjg.v17.i31.3596
Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs
Ming-Liang Wang, Fei Miao, Yong-Hua Tang, Xue-Song Zhao, Jie Zhong, Fei Yuan
Ming-Liang Wang, Fei Miao, Yong-Hua Tang, Xue-Song Zhao, Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Jie Zhong, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Fei Yuan, Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Author contributions: Miao F conceived the study concept and design and revised the draft paper; Wang ML performed acquisition, analysis and interpretation of the radiographic data and wrote the draft; Tang YH and Zhao XH shared the work of acquisition and analysis of the radiographic data; Zhong J acquired and analyzed the endoscopy data; Yuan F acquired and analyzed the pathology data.
Supported by Shanghai Leading Academic Discipline Project, No. S30203; and Key project in biological medicine of Shanghai Science and Technology Commission, No. 10411953200
Correspondence to: Fei Miao, MD, Professor, Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197, Ruijin 2nd Road, Shanghai 200025, China. mf11066@rjh.com.cn
Telephone: +86-21-64370045 Fax: +86-21-54665108
Received: December 11, 2010
Revised: January 22, 2011
Accepted: January 29, 2011
Published online: August 21, 2011
Abstract

AIM: To summarize clinical, endoscopic, radiologic and pathologic features of special diaphragm-like strictures found in small bowel, with no patient use of non-steroidal anti-inflammatory drugs (NSAIDs).

METHODS: From January 2000 to December 2009, 5 cases (2 men and 3 women, with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures of small bowel on imaging, operation and pathology. All the patients denied the use of NSAIDs. The clinical, endoscopic, radiologic and pathologic findings in these 5 patients were retrospectively reviewed from the hospital database. Images of capsule endoscopy (CE) and small bowel follow-through (SBFT) obtained in 3 and 3 patients, respectively, and images of double-balloon enteroscopy and computed tomography enterography (CTE) obtained in all 5 patients were available for review.

RESULTS: All patients presented with long-term (2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia. There was only one stricture in four cases and three lesions in one case, and all the lesions were located in the middle or distal segment of ileum. Circumferential stricture was shown in the small bowel in three cases in the CE image, but the capsule was retained in the small bowel of 2 patients. Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient. The lesions were shown as circumferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE (in all 5 cases), SBFT (in 2 cases) and double-balloon enteroscopy (in all cases). On microscopy, a chronic inflammatory infiltrate and circumferential diaphragm were found in all lesions.

CONCLUSION: Diaphragm-like strictures of small bowel might be a special consequence of unclear damaging insults to the intestine, having similar clinical, endoscopic, radiologic and pathologic features.

Keywords: Small bowel; Gastrointestinal bleeding; Diaphragm; Stricture; Endoscopy; Computed tomography; Enterography