Overview
Diaphragm disease is a severe form of non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy characterized by multiple circumferential stenoses in the small bowel, often presenting as acute small bowel obstruction 1.Diagnosis
Key Diagnostic Criteria: Macroscopically detected thin diaphragm-like mucosal folding inside the bowel lumen 1.
Recommended Tests: Gross examination during surgery, histological confirmation if possible 1.
Grading: Not explicitly detailed in the provided abstracts 1.Management
First-Line Treatments: Emergency surgical intervention for bowel obstruction 1.
Adjunctive Treatments: Discontinuation of NSAIDs, supportive care including fluid resuscitation and nutritional management 1.
Specific Drug Classes: No specific drug doses mentioned beyond NSAID cessation 1.Special Populations
Pregnancy: Not addressed in the provided abstracts 1.
Pediatrics: Not addressed in the provided abstracts 1.
Elderly: Not addressed in the provided abstracts 1.
Comorbidities: Increased risk with prolonged NSAID use; careful consideration of comorbidities impacting surgical risk 1.Key Recommendations
Perform emergency surgery for suspected diaphragm disease presenting as acute small bowel obstruction 1 (Evidence: Strong).
Discontinue NSAIDs post-diagnosis to prevent recurrence 1 (Evidence: Moderate).
Provide supportive care including fluid and nutritional support post-surgery 1 (Evidence: Expert opinion).References
1 Sarma DR, Bhattacharya P. Diaphragm disease in emergency surgery. British journal of hospital medicine (London, England : 2005) 2020. link
2 Nuss AB, Forschler BT, Crim JW, Brown MR. Distribution of neuropeptide F-like immunoreactivity in the Eastern Subterranean termite, Reticulitermes flavipes. Journal of insect science (Online) 2008. link