Diaphragm Disease of Small Bowel - The Unsolved Mystery and an Emerging Disease
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
Diaphragm disease is typical of NSAID-related injury of the small intestine but remains an uncommon, although not vanishingly rare, occurrence: 2% of patients taking NSAIDs and COX-2 inhibitors long-term, Diaphragm disease developes. 20-year-old patient presented to casualty of our hospital with pain abdomen,distension,vomiting since 4 days. Patient came with 4 day old multiple ileal perforations with severe fecal peritonitis. Emergency laparotomy was done and patient was managed postoperatively with prolonged ventilator support, inotropic support, higher antibiotics for severe sepsis. On Postoperative day 14 very unlikely the patient developed enterocutaneous fistula when the patient was already mobilizing, tolerating orally and passing stools. So a very unlikely picture of low output enterocutaneous fistula was decided to be managed conservatively with improving patients nutritional status. After 6 weeks the fistula didn’t heal so fistulogram was done and re- exploration was planned. Post re- exploration again patient developed an enterocutaneous fistula which healed in another 3 weeks and the stoma was functioning. Granulomatous conditions affecting the bowel are Tuberculosis, Crohns Disease and Diaphragm disease of small bowel. As in our case recurrent enterocutaneous fistulas made us doubt the diagnosis thinking it is crohns disease and whether to start azathioprine and steroids. The histopathologist was very sure of the diagnosis as there were was pyloric gland metaplasia or neuronal hyperplasia. It was extremely challenging and difficult to manage the disease over a period of 10 weeks when the disease entity is so new and hardly any literature is available. Hence our case report serves as a future reference point for other surgeons who will come across such rare entity.
Authors and Affiliations
Dr. Siddharth Kalke
Keywords
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