A rare case of idiopathic multiple small bowel strictures in Indian subcontinent: a case report

Small bowel ulcers and strictures are uncommon but when they occur they can be an important cause of morbidity. We reported a case of a multiple strictures in small bowel that was treated surgically pain for 15 years. She also had hypoalbuminemia and iron deficiency anemia. A diagnosis of small bowel stricture was made on CT and surgery was advised. Resection of the 100 cm long segment of small bowel was done. Approximately 10 smooth strictures were identified in the resected segment. Histology did not identify any specific cause. A 43 year old Indian female was diagnosed with subacute small bowel obstruction. She had a history of chronic abdominal pain for 15 years. She also had hypoalbuminemia and iron deficiency anemia. A diagnosis of small bowel stricture was made on CT and surgery was advised. Resection of the 100 cm long segment of small bowel was done. Approximately 10 smooth strictures were identified in the resected segment. Histology did not identify any specific cause. Subacute small bowel obstruction can be associated with various factors. Multiple idiopathic small bowel strictures can be considered as one of the causes. In present case no cause of ulcers and strictures could be found. Idiopathic multiple bowel strictures with fecalith is rare. Histopathology and other investigations revealed no specific cause. We recorded no postoperative complications 2 months after surgery by resection and anastomosis.

Endoscopy Capsule Retention in a Young Female with Small Bowel Strictures Secondary to Non-Steroidal Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause small bowel damage, which could present in different ways, including abdominal pain and occult gastrointestinal bleeding. NSAID use can also result in small bowel strictures, which can be challenging to diagnose and manage. Here, we describe a case of a 49-year-old female who presented with chronic anaemia and intermittent abdominal pain, with a history of NSAID use. She underwent capsule endoscopy as part of the workup for anaemia and subsequently had capsule retention due to a small bowel stricture.

P324 Deep enteroscopy after balloon dilatation for differential diagnosis of small bowel stricture

Background Use of non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin may result in gastrointestinal complications including ulceration, bleeding, and stricture. Chronic fibrosis and chronic ulcerations form bowel stricture which is the most severe stage of NSAIDs induced enteropathy. Capsule endoscopy and balloon enteroscopy may provide detailed information of small bowel mucosal lesions such as longitudinal ulceration suggesting Crohn’s disease. However, more distal or proximal evaluation above stricture is impossible due to severe stricture. Nowadays, balloon dilatation through the enterosope is available and can dilate stricture site by expanding force. This technique allows enteroscope to pass of stricture site and provides accurate evaluation of more proximal or distal small bowel above the stricture. We report our experience of small bowel evaluation after balloon dilatation. Methods Nine patients with small bowel stricture and history of NSAIDs between 2012 February and 2019 October were analysed. All patients with small bowel stricture had symptoms including abdominal pain, abdominal fullness, or vomiting and enteroscope could not pass the stricture site. Balloon dilatations were performed with through the scope balloon from 8 mm to 15 mm diameter in these patients. After adequate dilation, enteroscope passage could pass the stricture site. Detailed mucosal evaluation of more proximal or distal small bowel above the stricture was performed. Results Successful and adequate balloon dilation of small bowel stricture was achieved in 9 of 9 patients. Additional deep and longitudinal ulceration suggesting Crohn’s disease was found after successful passage of enteroscope in 3 of 9 patients. In 6 of 9 patients, additional chronic shallow ulcerative lesions without deep and longitudinal ulceration was found after eneteroscope passage. Deep enteroscopy after balloon dilatation provided important diagnostic clue and treatment strategy in 3 of 9 patients. Conclusion Deep small bowel evaluation above the stricture after balloon dilatation may provide additional and detailed information for differential diagnosis of small bowel stricture.