Colonic diaphragm disease without significant non-steroidal anti-inflammatory drug use: a case report

Jo C Roche,Geraint T Williams,Michael H Lewis,Gareth Morris-Stiff,Carrie Champ

doi:10.1186/1757-1626-1-247

Jo C Roche, Geraint T Williams + Show 3 more

Open Access

https://doi.org/10.1186/1757-1626-1-247

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Abstract

IntroductionColonic diaphragm disease is an uncommon condition usually associated with the long-term use of non-steroidal anti-inflammatory drugs.Case presentationA 48-year-old woman presented as an emergency patient with abdominal pain and vomiting. Past medical history included inflammatory bowel disease of ulcerative colitis type for which she was taking azathioprine and prednisolone. On examination, she was shocked with signs of peritonism. Following resuscitation, she was taken for a laparotomy upon which a small amount of turbid fluid was identified but there was no direct evidence of an intra-abdominal perforation. A peritoneal lavage was performed and she was taken to the intensive care unit. A repeat laparotomy was performed on the sixth postoperative day, following a clinical deterioration and again no leak was identified. Given the history of ulcerative colitis, the perforation was presumed to be of colonic origin and a total colectomy and ileostomy was performed. Histopathological examination of the colectomy specimen revealed extensive colonic diaphragm disease with 30 thin-walled diaphragms, one of which reduced the lumen to a pin-hole. No perforation was identified.ConclusionTo the best of the our knowledge, this is the first report of the development of colonic diaphragm disease in the absence of a history of non-steroidal anti-inflammatory drug ingestion. Given the history of ulcerative colitis we believe that the disease may have arisen as a result of the healing of the underlying inflamed colon rather than as a direct effect of non-steroidal anti-inflammatory drugs.

Highlights

Colonic diaphragm disease is an uncommon condition usually associated with the long-term use of non-steroidal anti-inflammatory drugs.Case presentation: A 48-year-old woman presented as an emergency patient with abdominal pain and vomiting
To the best of the our knowledge, this is the first report of the development of colonic diaphragm disease in the absence of a history of non-steroidal anti-inflammatory drug ingestion
Given the history of ulcerative colitis we believe that the disease may have arisen as a result of the healing of the underlying inflamed colon rather than as a direct effect of non-steroidal anti-inflammatory drugs

Summary

Conclusion

To the best of our knowledge, it would appear that this is the first reported case of diaphragm disease of the large bowel in the apparent absence of long-term NSAIDs. We would suggest that this supports the hypothesis put forward by Going et al [3] in 1993 that diaphragm disease is the result of healing insults on the bowel mucosa, in this case in the form of inflammatory bowel disease. Written informed consent could not be obtained in this case since the patient is deceased and the next-of-kin were untraceable. We believe this case report contains a worthwhile clinical lesson which could not be made as effectively in any other way. We expect the next-of-kin would not object to the publication of this case. All efforts have been made to ensure that the risk of identification of this patient has been minimised to prevent the identity of the patient being revealed, either to others or to the patient's relatives

Introduction

Discussion