Abstract
A 75-year-old woman who had been on medication with oral non-steroidal anti-inflammatory drugs (NSAIDs) for chronic rheumatism, complained of abdominal pain and black vomit. She was admitted to our hospital because of severe anemia and small intestinal obstruction. The source of bleeding was not found on gastroscopy or colonoscopy, but tarry stool and anemia progressed after her hospitalization. Surgery was performed under a diagnosis of occult small intestinal bleeding. During surgery, many indurations were noted throughout most of the small intestine. Intraoperative endoscopic examination via cecum showed ileal membranous stricture through which the endoscope could not pass. Since there was no intestinal obstruction, nor additional fresh bleeding, no further surgical intervention was planned. However, after the first operation, the intestinal obstruction progressed, and the operation was performed again. Intraoperative endoscopic examination was performed again via the jejunum and revealed the whole small intestine. Then we found two severe pin hole-like strictures. The part of the small intestine responsible for the intestinal obstruction was resected.
This case supposes that the multiple small intestinal strictures could be due to long term use of NSAIDs. Precise diagnosis and the decision for the extent of the small intestine resection were able to be done by intraoperative endroscopy.
