R El Qadiry, A Lalaoui, H Nassih, I Aitsab, A Bourrahouat
Pediatric B Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco.
Clin Med Insights Case Rep. 2021 Jan 13;14:1179547620986152. doi: 10.1177/1179547620986152. eCollection 2021.
Intussusception is the most common cause of small bowel obstruction in children under 4 years of age. Intussusception is not a widely recognized complication of celiac disease.
We present a clinical case of a 23-month-old boy with a 1-month history of watery diarrhea complicated by 2 episodes of intestinal obstruction, both had required surgery. He presented with acute and severe abdominal distention with bilious vomiting, and an appearance of intussusception on abdominal ultrasound. Upon further investigation, the diarrhea was found to be malabsorptive. The diagnosis of celiac disease was confirmed by the presence of specific serum autoantibodies (IgA Tissue transglutaminase and endomysium Antibodies >200 UI/ml with normal serum IgA level). He started a gluten-free diet and his symptoms were almost completely resolved.
Recurrent intussusception may be associated with celiac disease, so celiac serology is recommended in children with recurrent intussusceptions. However, intestinal tuberculosis and lymphoma associated with enteropathy should be considered in the differential diagnosis. Intussusception in celiac disease is usually transient and should be managed expectantly rather than early surgical reduction.
肠套叠是4岁以下儿童小肠梗阻最常见的原因。肠套叠并非乳糜泻广泛认可的并发症。
我们呈现了一名23个月大男孩的临床病例，该男孩有1个月水样腹泻病史，并伴有2次肠梗阻发作，均需手术治疗。他表现为急性严重腹胀伴胆汁性呕吐，腹部超声显示有肠套叠表现。进一步检查发现腹泻为吸收不良性。通过特异性血清自身抗体（IgA组织转谷氨酰胺酶和肌内膜抗体>200 UI/ml且血清IgA水平正常）确诊为乳糜泻。他开始了无麸质饮食，症状几乎完全缓解。
复发性肠套叠可能与乳糜泻有关，因此对于复发性肠套叠患儿建议进行乳糜泻血清学检查。然而，鉴别诊断时应考虑肠道结核和与肠病相关的淋巴瘤。乳糜泻相关的肠套叠通常是短暂的，应采取保守治疗而非早期手术复位。
