ADVERTISEMENT

Colonic Diaphragm Disease: An Important NSAID Complication to Know

Given the widespread use of nonsteroidal anti-inflammatory drugs, physicians should recognize the symptoms of colonic diaphragm disease, a rare but serious complication that can affect the large and small intestines.
Federal Practitioner. 2017 March;34(3):38-40
March 20, 2017|Federal Practitioner
Laurie Farricielli, MD;CAPT Dorothy J. Sanderson, MD, USPHS
Author and Disclosure Information

Dr. Farricielli is a hospitalist, and CAPT Sanderson is chief, internal medicine, both at the Phoenix Indian Medical Center in Arizona.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Treatment

Recommendations include NSAID withdrawal, endoscopic/fluoroscopic dilatation, and surgical resection. Outcomes with these treatment approaches have been highly variable. For some patients, NSAID withdrawal alone or following resection has resulted in success. However, even with withdrawal of NSAIDs, symptoms may improve, although the histologic findings of CDD may not be reversed.3,6 In one case report, a colonic stricture persisted endoscopically after NSAID withdrawal but resolved after a 20-week course of prednisone.7

Conclusion

Despite NSAID cessation, the patient in this case study presented a month later with an acute bowel obstruction. The bowel obstruction responded to conservative treatment, and the patient declined surgical intervention. The patient was readmitted again 4 months later with an acute bowel obstruction, and underwent an emergent colonic resection. The pathology report was consistent with CDD. In the 3 years since the resection, the patient has had no recurrences and continues to avoid all NSAIDs. She has refused a follow-up postresection colonoscopy.

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT