Diaphragm-like strictures of the ileum associated with NSAID use: A rare complication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for man y conditions including arthritis. A rare complication of their use is diaph ragm-like strictures of the small and large intestines. A 65-year-old woman with a 12-year history of arthritis came to us with a 35-pound weight loss and anorexia. She had been taking piroxicam for 3 years. Evaluation includ ing enteroclysis revealed multiple mid-heal diaphragm-like strictures and p roximal small bowel dilatation. The symptoms persisted despite discontinuan ce of the drug. Abdominal exploration with intraoperative enteroscopy revea led five heal strictures within a short segment of bowel. Resection was don e and completion enteroscopy showed no other strictures. The patient recove red uneventfully and had full resolution of the symptoms. We discuss the di fficulties in diagnosis and management of this drug complication and briefl y review the literature.