A case of the stenosis of the terminal ileum during taking NSAIDs

Abstract

A 73-year-old male, who had been diagnosed with rheumatoid arthritis and taking NSAIDs for a long time. He was pointed out the stenotic lesion of his ileum in a previous hospital. A double balloon enteroscope in our hospital showed the stenosis of his terminal ileum. It was difficult to go through the stenosis. Perforation of the terminal ileum was seen after the second balloon dilatation with a double balloon enteroscope. Then, resection of the small intestine was performed. The resected specimen showed the stenosis of the terminal ileum with thickness of the intestinal wall and perforation was seen in the most stenosed terminal ileum. UL-I or UL-II ulcer was seen in oral side of the stenosis. Histopathological findings showed marked fibrosis of the submucosal layer and the vascularity in the mucosal layer. These histopathological findings maked us consider the stenosis of the terminal ileum caused by ischemic enteritis rather than NSAIDs-induced enteritis.
In conclusion, this case may indicate the risk of endoscopic dilatation therapy of stenotic lesion of the terminal ileum in case of a prolonged NSAIDs user.