A case of small intestinal edematous stenosis caused by NSAIDs

Abstract

A 67-year-old woman who treated with NSAIDs for coronary disease, visited our hospital with complaining blood stool in July, 2010. She presented two years later with bloody stools. She was referred to our hospital with suspected gastrointestinal bleeding. Abdominal ultrasonography revealed thickening of the small intestinal wall, and the patient was admitted with suspected small intestinal hemorrhage. Upper GI endoscopy and colonoscopy was performed, but the point of hemorrhage was not detected. Capsule enteroscopy (CE) was performed and a lesion of mucosal erosion with inflammation was found. Based on slow endoscopic capsule movement, stricture was suspected in the distal portion of the small intestine. After CE, single-balloon enteroscopy via the transanal approach was performed. Mucosal erosion and edematous stenosis in the ileum were diagnosed. NSAIDs cause mucous membrane disorders including annular ulcers. Strictures form with repeated healing followed by recurrence. The morphology of these disorders is of membrane-like stricture. No edematous strictures have been reported. This case showing mucosal changes was still in the acute stage and is reported as an illustration of the preclinical stage that would subsequently progress to membrane-like stricture formation.