A case of nonspecific multiple ulcers of the small intestine diagnosed with the aid of intraoperative endoscopy

Abstract

Nonspecific multiple ulcers of the small intestine (NMUS) is a clinical entity proposed in Japan with characteristic clinical features different from other inflammatory bowel disease such as Crohn's disease. A 57-year-old woman was admitted to our hospital because of refractory anemia and hypoproteinemia. She previously underwent ileocecal resection due to NMUS when she was 34 years old, but the detailed findings were not available. Then she was found to have multiple colonic ulcers and had been treated with salazosulfapyridine under the diagnosis of Crohn's disease. Laboratory data on admission showed severe anemia, hypoproteinemia. She didn't have the history of hematomesis nor melena, but fecal occult blood tests were always positive and the anemia was progressive requiring multiple blood transfusions. Colonoscopy revealed multiple colonic ulcerations and anastomotic stenosis, not inconsistent with Crohn's disease. Conventional investigations including gastroduodenoscopy and fluoroscopic small bowel examination failed to detect ulcer lesions in the small intestine. Our tentative diagnosis was Crohn's disease, but the possibility of NMUS could not be ruled out because of her past medical history. Then laparotomy was performed and an intraoperative enteroscopy revealed multiple shallow ulcers with bleeding along the whole small intestine. She was diagnosed as NMUS according to the endoscopic features characteristic of NMUS.