DIAPHRAGM-LIKE STRICTURES OF THE SMALL-BOWEL IN PATIENTS TREATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS

The radiological findings are described in four patients who developed strictures of the small bowel, and who had received non-steroidal, anti-inflammatory drugs (NSAIDs) for 1.5-15 years. Clinical presentation was that of subacute small bowel obstruction. Small bowel barium studies showed multiple discrete strictures. Some strictures were indistinguishable from those of regional enteritis. Others however were narrow 'diaphragm-like' septae encroaching on and markedly narrowing the ileal lumen, and shown histologically to be due to submucosal fibrosis. It is suggested that these strictures are likely to be consequent on NSAIDs administration and that radiologists and surgeons need to be aware of these 'diaphragms' which can be very difficult to detect on barium examination, either small bowel follow-through or enteroclysis, and at laparotomy.