AlAhmad Maryam, Almessabi Abdulqader
Gastroenterology Fellow, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
Gastroenterology Consultant, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
Case Rep Gastroenterol. 2022 Feb 14;16(1):44-48. doi: 10.1159/000521542. eCollection 2022 Jan-Apr.
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.
乳糜泻（CD）是一种慢性免疫介导的小肠疾病。组织转谷氨酰胺酶（TTG）抗体检测是CD诊断的第一步。肠套叠是一段肠管套入相邻肠段肠腔的过程。尽管如此，成人肠套叠与CD之间的关联此前已有描述，但仍未得到广泛认可。我们报告一例以成人肠套叠为CD首发表现的病例。一名28岁非酒精性、不吸烟且既往健康的男性因进行性弥漫性腹痛伴腹胀、恶心、呕吐、腹泻及体重减轻7kg，病史1周，就诊于急诊科。体格检查显示体型消瘦，无淋巴结肿大。实验室检查显示低色素小细胞性贫血、AST 214 IU/L、ALT 217 IU/L、碱性磷酸酶183 IU/L及INR 2.9。腹部X线片显示小肠和大肠肠袢充气扩张。进行了腹部增强计算机断层扫描，显示至少3处小肠套叠，呈靶征，无梗阻迹象，提示小肠肠套叠。根据这一影像学结果，患者被收入普通外科，禁食。手术团队联系胃肠病学团队进行推进式小肠镜检查及活检，但患者拒绝。进一步检查包括TTG抗体；IgA和IgG显著升高，分别为4965.5 CU和431.9 CU（参考值：<19.9 CU）。诊断为CD导致成人肠套叠。建议患者开始无麸质饮食。住院期间，患者症状完全缓解后出院。总之，本病例突出了成人肠套叠与CD之间的潜在联系。成人肠套叠是一种罕见疾病，应仔细调查其潜在病因，以加快治疗并防止不必要的手术干预。
