Rare cause of small bowel obstruction: diaphragm disease.

Diaphragm disease is a rare cause of small bowel obstruction, caused by circular fibrotic membranes resulting in a narrowed intestinal lumen. It is associated with prolonged non-steroidal anti-inflammatory drug use, and often requires surgical resection. We report the case of a man in his 50s presenting with recurrent anaemia and intermittent small bowel obstruction. Exploratory laparoscopy identified three distinct areas of congested, thickened and narrowed ileum. Symptoms resolved following small bowel resection. Histological examination found elongated mucosal folds with ulceration and submucosal fibrosis consistent with diaphragm disease. Common radiological findings include small bowel strictures and thickening, mucosal hyperenhancement, and small bowel dilatation. In this case, on retrospective review of the initial CT scan, it is possible to appreciate circumferential mural thickening correlating with the histological findings. This case highlights the importance of rigorous examination of CT imaging and the utility of exploratory laparoscopy in diagnosing diaphragm disease.

Tonsillar Extraintestinal Enteropathy-Associated T-Cell Lymphoma in a Patient With Celiac Disease.

Enteropathy-associated T-cell lymphoma (EATL) is a rare but serious complication of celiac disease. Diagnosis is challenging. Patients can present with weight loss, abdominal pain, and diarrhea or acutely with bowel perforation or obstruction. Patients often present with advanced disease. Malnutrition further limits treatment options. Early diagnosis is important to start aggressive treatment strategies. However, even with prompt diagnosis, prognosis remains poor with a high mortality rate. We report the first documented case of sole tonsillar involvement, a rare extraintestinal and extranodal site of disease, leading to EATL diagnosis. We also highlight some of the challenges in diagnosing EATL.