Kehagias Ioannis, Karamanakos Stavros N, Panagiotopoulos Spyros, Giali Sofia, Gogos Charalambos A, Kalfarentzos Fotis
Department of Surgery, School of Medicine, University of Patras, Rion University Hospital, 26500, Patras, Greece.
J Med Case Rep. 2009 Feb 11;3:61. doi: 10.1186/1752-1947-3-61.
Although a common cause of intestinal obstruction in children, intussusception is a rare event in the adult population living in temperate regions. It has long been known that various acquired immune deficiency syndrome related conditions of the bowel such as lymphoma, lymphoid hyperplasia, cytomegalovirus colitis and Kaposi's sarcoma can lead to intussusception. The diagnosis is particularly difficult in this population of patients due to the non-specific nature of the symptoms as well as the depressed immune response obscuring inflammation or ischemia. Though the reported acquired immune deficiency syndrome associated cases of intussusception refer to patients with known human immunodeficiency virus infection, in our case we present an intestinal intussusception as the first manifestation of human immunodeficiency virus infection.
A 58-year-old white heterosexual Greek man with a clean medical record and no history of abdominal operation presented to the emergency department with symptoms and signs of bowel obstruction. Plain abdominal radiographs were highly suspicious for intussusception which was eventually confirmed on a computed tomography scan. Due to the patients clean medical record as well as the radiologic diagnosis of intussusception, we promptly undertook further serologic tests for human immunodeficiency virus and eventually established the diagnosis of acquired immune deficiency syndrome. The patient was operated 3 days later and this confirmed the diagnosis of small-bowel invagination due to a 4 cm polypoid growing intraluminal tumor, the pathologic examination of which revealed a diffuse high-grade B cell lymphoblastic lymphoma.
Human immunodeficiency virus infection may have a silent course and gastrointestinal manifestations of the disease leading to intussusception might be the first clinical sign. Patients with intestinal intussusception, and the presence of risk factors for human immunodeficiency virus infection should be eligible for serologic tests for human immunodeficiency virus infection.
尽管肠套叠是儿童肠梗阻的常见病因，但在温带地区的成年人群中却是罕见事件。长期以来，人们已知各种与获得性免疫缺陷综合征相关的肠道疾病，如淋巴瘤、淋巴样增生、巨细胞病毒性结肠炎和卡波西肉瘤，可导致肠套叠。由于症状的非特异性以及免疫反应低下掩盖了炎症或缺血，在这类患者中诊断尤为困难。尽管报道的与获得性免疫缺陷综合征相关的肠套叠病例是指已知感染人类免疫缺陷病毒的患者，但在我们的病例中，我们呈现了一例以肠套叠为人类免疫缺陷病毒感染首发表现的病例。
一名58岁、无腹部手术史且病历清白的白人异性恋希腊男子因肠梗阻症状和体征就诊于急诊科。腹部平片高度怀疑为肠套叠，最终计算机断层扫描得以确诊。鉴于患者病历清白以及肠套叠的影像学诊断，我们迅速对其进行了人类免疫缺陷病毒的进一步血清学检测，最终确诊为获得性免疫缺陷综合征。患者3天后接受手术，证实为小肠套叠，病因是一个4厘米的腔内息肉样生长肿瘤，病理检查显示为弥漫性高级别B细胞淋巴细胞淋巴瘤。
人类免疫缺陷病毒感染可能病程隐匿，该疾病导致肠套叠的胃肠道表现可能是首个临床症状。患有肠套叠且存在人类免疫缺陷病毒感染风险因素的患者应接受人类免疫缺陷病毒感染的血清学检测。
