Diaphragm disease in emergency surgery

Area of Science:

• Gastroenterology
• Surgical Pathology
• Pharmacology

Background:

• Diaphragm disease of the small bowel is a rare, severe manifestation of non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy.
• It characteristically presents with multiple circumferential stenoses within the small intestine.
• This condition often leads to acute small bowel obstruction, necessitating emergency surgical intervention.

Purpose of the Study:

• To conduct a systematic review of histologically-proven diaphragm disease of the small intestine.
• To identify risk factors associated with its development.
• To evaluate patient outcomes in those undergoing emergency surgery for small bowel obstruction.

Main Methods:

• A comprehensive literature search was conducted from January 1975 to March 2019 using relevant Medical Subject Headings (MeSH) terms.
• Studies were selected based on predefined inclusion criteria, focusing on diaphragm disease defined by macroscopic thin, diaphragm-like mucosal folds.
• Data extracted included patient demographics, NSAID usage, surgical procedures, complications, and diagnostic presentations.

Main Results:

• Twenty-one studies comprising 17 case reports, one case series, and three retrospective comparative studies were analyzed, involving 29 patients.
• All patients had a history of non-steroidal anti-inflammatory drug (NSAID) use, averaging 3-5 years.
• Female patients and those with over 7 years of NSAID use were more prevalent in comparative studies, with all patients presenting with acute small bowel obstruction requiring laparotomy.

Conclusions:

• Diaphragm disease is a rare and challenging diagnosis, often confirmed intraoperatively by the characteristic circumferential bowel stenosis.
• Long-term NSAID use and female gender are identified as significant risk factors.
• Early diagnosis is crucial due to the high risk of acute small bowel obstruction in affected patients.