Small Intestinal Ulceration in Two Recurrence-Free Young Patients at 10 Years Postoperatively

Small intestinal ulcers are occasionally observed in daily medical practice, and although diagnostic abilities have improved in recent years and the disease pathogenesis has been elucidated, recurrence remains common, requiring proper therapeutic intervention. Herein, we report two cases of small intestine ulceration in young patients who did not experience recurrence for a long period of time after appropriate treatment at disease onset. Case 1 was of a 34-year-old woman who had been taking diclofenac sodium. She was diagnosed with intestinal obstruction through abdominal computed tomography (CT). The patient underwent partial resection of the obstructed ileum. Histopathological examination revealed fibrosis in the submucosa, leading to a diagnosis of stenosis secondary to drug-induced small intestinal ulceration caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Postoperatively, the NSAIDs were changed to a selective COX-2 inhibitor (celecoxib). Case 2 was of a 33-year-old man who underwent emergency surgery after an abdominal CT revealed free air. A perforation was found in the small intestine, and the area was resected. Histopathological examination revealed only nonspecific inflammatory findings, leading to a diagnosis of perforation due to a simple small intestinal ulcer. No recurrence was observed in 10 years in both cases. Thus, appropriate management of simple, nonmalignant small intestinal ulcers at initial presentation could be the only treatment needed, with long postoperative recurrence-free periods. These cases demonstrated that proper management of simple, nonmalignant small intestinal ulcers at the initial presentation can be the only treatment needed for long postoperative recurrence-free periods. With an aging society and improved diagnostic capabilities, small intestinal ulcers may become more common in the future. Therefore, the possibility of small intestinal ulceration should be considered when diagnosing ulcerative lesions of the gastrointestinal tract, such as acute abdomen.