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MIOT Hospitals Cures UK Patient of Rare Drug-induced Disease of the Diaphragm;First Such Case Report
The prolonged use of painkillers caused UK-based Jasbir Kaur Chahal to develop a rare and debilitating disease of the diaphragm. Thanks to MIOT Hospitals, she has completely recovered.
By: MIOT Hospitals
Jasbir Kaur suffered from Ankylosing Spondylitis - a painful condition that affects the spine. For this, she had been on prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain-relief which, in turn, had caused a diaphragm disease.
The patient had been on liquid and low roughage diet for several months in order to avoid intestinal obstruction. The possibility of drug (NSAID)-induced diaphragm disease is a very rare condition.
On evaluation, CT enteroclysis and MRI enteroclysis revealed multiple strictures in the distal ileum. In order to confirm the findings and make a definitive diagnosis, a Double Balloon Enteroscopy had to be performed; this is a difficult procedure involving the use of an enteroscope, supported by balloons, and slid into the affected portion of the intestine.
Dr. Arulprakash, an expert in this procedure, chose the difficult option of going in through the colon, past the ileocaecal junction into the small intestine. Multiple areas of stricture were identified and biopsied.
The histopathology showed ulceration and submucosal chronic inflammation.
MIOT Hospitals’ GI surgeons headed by Prof. Baskaran decided to do a Stricturoplasty or Resection.
During the surgery, Dr. Arulprakash assisted the surgeons by passing an endoscope to reach the area of involvement. It was evident that the lesion involved was two feet of the small intestine with nine membrane-like strictures. Prof. Baskaran then proceeded to resect the involved two-foot segment and anastamosed the uninvolved ends of the bowel.
After the surgery, Jasbir Kaur Chahal was able to eat a full meal after nearly after 3 years of pain and discomfort and is now well and ready for discharge.
Highlights of Treatment:
- In India, there is considerable use and abuse of NSAIDs, which are pain killers bought over the counter from pharmacies. Diaphragm Disease presents in patients with Chronic NSAID abuse.
- Diaphragm disease presents with intestinal obstruction. The investigation of choice is enteroscopy, which is a procedure to view the small intestine using a Double Balloon Enteroscope. This technique demands tremendous skill and dexterity and only an expert in this procedure can skillfully use the Double Balloon Enteroscope to identify the lesion and make a diagnosis.
- The multi-disciplinary team at MIOT International, led by the GI medical team and GI surgeons, conducted the procedure together in the Operation Theatre and helped confirm the diagnosis and proceed with surgical resection, which eventually lead to a cure.
- This is the first such case reported in India.
Read more information on the MIOT Advanced Center for Gastrointestinal and Liver Diseases. (http://www.miothospitals.com/
Page Updated Last on: Jul 16, 2014