Acute intestinal obstruction caused by multifocal nodular inflammatory disease of the small intestine: a case report and literature review

TL;DR

A rare intestinal condition causing blockage was diagnosed through surgery and biopsy in a patient with abdominal pain and distension.

Contribution

Highlights the importance of laparoscopy and biopsy in diagnosing multifocal nodular inflammatory disease of the small intestine.

Findings

Diagnostic laparoscopy confirmed absence of internal hernia and identified multiple nodules in the small intestine.

Histopathology showed chronic inflammation, lymphoid hyperplasia, and ulceration consistent with CMUSE.

The patient recovered well with anti-inflammatory therapy and remained asymptomatic during follow-up.

Abstract

Multifocal nodular inflammatory disease of the small intestine is a rare cause of acute intestinal obstruction. We report such a case to discuss its diagnostic approach, emphasizing the role of surgical intervention and pathological examination, thereby aiming to improve clinical recognition of this condition.

We analyzed the clinical data of a 33-year-old male patient who was admitted with intermittent abdominal pain and distension for one week, which aggravated over one day. Emergency computed tomography (CT) revealed obstruction of the proximal jejunum with inflammatory changes, raising suspicion of internal hernia. Diagnostic laparoscopy confirmed the absence of internal hernia and volvulus, and no bowel resection was performed. Multiple nodules were observed throughout the small intestine, accompanied by thickened and edematous intestinal wall at the site of obstruction in the proximal small bowel. One intestinal nodule was biopsied during surgery for pathological examination. Histopathological findings indicated chronic mucosal inflammation, lymphoid follicular hyperplasia, superficial ulceration with acute inflammatory cell infiltration, extensive edema, and focal hemorrhagic changes. Postoperative management included anti-inflammatory therapy and nutritional support. The patient recovered well and was discharged. During a 9-month follow-up, he remained asymptomatic with normal dietary intake and bowel function, without recurrence of the disease.

This case of multifocal nodular inflammatory disease of the small intestine was most consistent with Cryptogenic Multifocal Ulcerating Stenosing Enteropathy (CMUSE), a rare inflammatory disorder characterized by multiple superficial ulcers and stenotic lesions in the small intestine. Although rare, CMUSE can lead to intestinal obstruction. Diagnostic laparoscopy and pathological biopsy are crucial for its diagnosis.

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