Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease
Celiac disease (CD) is a chronic immune-mediated small-intestinal disorder. The tissue transglutaminase (TTG) antibodies test is the initial step in the diagnosis of CD. Intussusception is a process where one segment of the bowel invaginates into the lumen of an adjacent segment. Despite that, the a...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2022-02-01
|
| Series: | Case Reports in Gastroenterology |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/521542 |
| _version_ | 1811245604603428864 |
|---|---|
| author | Maryam AlAhmad Abdulqader Almessabi |
| author_facet | Maryam AlAhmad Abdulqader Almessabi |
| author_sort | Maryam AlAhmad |
| collection | DOAJ |
| description | Celiac disease (CD) is a chronic immune-mediated small-intestinal disorder. The tissue transglutaminase (TTG) antibodies test is the initial step in the diagnosis of CD. Intussusception is a process where one segment of the bowel invaginates into the lumen of an adjacent segment. Despite that, the association between adult intussusception and CD has been descried previously, and it is still not widely recognized. We report a case of adult intussusception as the first manifestation of CD. A 28-year-old nonalcoholic and nonsmoker, previously healthy man, presented to the emergency department with a 1-week history of progressive diffuse abdominal pain associated with abdominal distension, nausea, vomiting, diarrhea, and 7 kg weight loss. The physical exam was remarkable for thin body habitus with no lymphadenopathy. Laboratory testing was significant for hypochromic microcytic anemia, AST 214 IU/L, ALT 217 IU/L, alkaline phosphatase 183 IU/L, and INR 2.9. An abdominal radiograph showed distended gas-filled small- and large-bowel loops. An abdominal computed tomography scan with contrast was done and demonstrated a telescoping of the small bowel in at least 3 areas with a target sign appearance with no signs of obstruction that suggested small-bowel intussusception. Following this imaging result, the patient was admitted under general surgery and kept nothing by mouth. The surgical team approached the gastroenterology team for push enteroscopy with biopsy which the patient refused. Further investigation included TTG antibodies; IgA and IgG were significantly elevated, 4,965.5 CU and 431.9 CU, respectively (reference: <19.9 CU). The diagnosis of CD leading to adult intussusception was made. The patient was advised to start a gluten-free diet. During the hospital stay, the patient had complete resolution of his symptoms and was discharged home. In summary, this case highlights the potential link between adult intussusception and CD. Adult intussusception is a rare condition that its underlying etiology should be meticulously investigated to expedite treatment and prevent unnecessary surgical intervention. |
| first_indexed | 2024-04-12T14:40:59Z |
| format | Article |
| id | doaj.art-b9e6c2d0682947b1af238429cf1d28de |
| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-04-12T14:40:59Z |
| publishDate | 2022-02-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-b9e6c2d0682947b1af238429cf1d28de2022-12-22T03:28:50ZengKarger PublishersCase Reports in Gastroenterology1662-06312022-02-01161444810.1159/000521542521542Transient Small-Bowel Intussusception Unmasking Adult Celiac DiseaseMaryam AlAhmad0https://orcid.org/0000-0002-2158-6130Abdulqader Almessabi1Gastroenterology Fellow, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab EmiratesGastroenterology Consultant, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab EmiratesCeliac disease (CD) is a chronic immune-mediated small-intestinal disorder. The tissue transglutaminase (TTG) antibodies test is the initial step in the diagnosis of CD. Intussusception is a process where one segment of the bowel invaginates into the lumen of an adjacent segment. Despite that, the association between adult intussusception and CD has been descried previously, and it is still not widely recognized. We report a case of adult intussusception as the first manifestation of CD. A 28-year-old nonalcoholic and nonsmoker, previously healthy man, presented to the emergency department with a 1-week history of progressive diffuse abdominal pain associated with abdominal distension, nausea, vomiting, diarrhea, and 7 kg weight loss. The physical exam was remarkable for thin body habitus with no lymphadenopathy. Laboratory testing was significant for hypochromic microcytic anemia, AST 214 IU/L, ALT 217 IU/L, alkaline phosphatase 183 IU/L, and INR 2.9. An abdominal radiograph showed distended gas-filled small- and large-bowel loops. An abdominal computed tomography scan with contrast was done and demonstrated a telescoping of the small bowel in at least 3 areas with a target sign appearance with no signs of obstruction that suggested small-bowel intussusception. Following this imaging result, the patient was admitted under general surgery and kept nothing by mouth. The surgical team approached the gastroenterology team for push enteroscopy with biopsy which the patient refused. Further investigation included TTG antibodies; IgA and IgG were significantly elevated, 4,965.5 CU and 431.9 CU, respectively (reference: <19.9 CU). The diagnosis of CD leading to adult intussusception was made. The patient was advised to start a gluten-free diet. During the hospital stay, the patient had complete resolution of his symptoms and was discharged home. In summary, this case highlights the potential link between adult intussusception and CD. Adult intussusception is a rare condition that its underlying etiology should be meticulously investigated to expedite treatment and prevent unnecessary surgical intervention.https://www.karger.com/Article/FullText/521542celiac diseaseintussusceptiontissue transglutaminase antibodiesdiarrheaabdominal pain |
| spellingShingle | Maryam AlAhmad Abdulqader Almessabi Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease Case Reports in Gastroenterology celiac disease intussusception tissue transglutaminase antibodies diarrhea abdominal pain |
| title | Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease |
| title_full | Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease |
| title_fullStr | Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease |
| title_full_unstemmed | Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease |
| title_short | Transient Small-Bowel Intussusception Unmasking Adult Celiac Disease |
| title_sort | transient small bowel intussusception unmasking adult celiac disease |
| topic | celiac disease intussusception tissue transglutaminase antibodies diarrhea abdominal pain |
| url | https://www.karger.com/Article/FullText/521542 |
| work_keys_str_mv | AT maryamalahmad transientsmallbowelintussusceptionunmaskingadultceliacdisease AT abdulqaderalmessabi transientsmallbowelintussusceptionunmaskingadultceliacdisease |