Invaginación intestinal como signo guía de enfermedad celíaca. Un caso clínico pediátrico / Intestinal intussusception as a key sign of Celiac Disease. A pediatric case report

La invaginación intestinal es la causa más frecuente de obstrucción intestinal entre los 6 y los 36 meses de edad. La mayoría son idiopáticas. Se ha descrito la asociación entre la enfermedad celíaca y la invaginación intestinal en la población pediátrica. Se presenta el caso de un varón de 23 meses ingresado por estancamiento ponderal en cuyo estudio ecográfico se observaron invaginaciones íleo-ileales asintomáticas repetidas.

Intestinal intussusception is the most frequent cause of intestinal obstruction between 6 and 36 months of age, the majority being idiopathic. The association between celiac disease and intestinal intussusception in the pediatric population has been described. We present the case of a 23-month-old male admitted due to a failure to thrive. In his ultrasound study recurrent asymptomatic ileo-ileal invaginations were found

Intussusception in celiac disease: Is it a common feature in children?

BACKGROUND AND AIM: There are sporadic reports of occurrence of intussusception in celiac disease (CD) but no systematic study yet. We prospectively studied the prevalence and natural history of intussusception in newly diagnosed CD. METHODS: From January 2010 to October 2013, 150 children, diagnosed to have CD on the basis of positive serology and duodenal biopsy, were recruited in this study. Abdominal ultrasonography was carried out before starting gluten-free diet (GFD) and repeated in those who had intussusception, on day 3 and then weekly till the resolution of intussusception. RESULTS: The median age was 72 (range, 16-204) months, and 79 (53%) were boys. Diarrhea was the presenting symptom in 119 (79%) cases. A total of 45 intussusceptions were detected in 37 (25%) children. Out of 45 intussusceptions, 95% involved small bowel. All but one had asymptomatic intussusception. On GFD, intussusception resolved spontaneously within 7 days in 65%, within 14 days in 84%, and within 28 days in 92% of cases, and none required surgical or hydrostatic reduction. On univariate analysis, younger age, low weight z score, presentation with diarrhea, abdominal distension, rickets, lower serum albumin, more severe villous atrophy, and refeeding syndrome were more common in children with intussusception. On multivariate analysis, abdominal distension and hypoalbuminemia were found to be significantly associated with intussusception. CONCLUSIONS: Intussusception is frequently (25%) seen in children with newly diagnosed CD, generally asymptomatic and resolves spontaneously on GFD. It is often associated with more severe disease. Children with CD and intussusception should not be subjected to surgical/radiological intervention.

Two jenuno-jenunal intussusceptions in a patient with coeliac disease.

We present a case of a 41-year-old woman with severe abdominal pain caused by two jejuno-jejunal intussusceptions. Further investigation showed coeliac disease as the underlying cause. The patient recovered rapidly on a gluten-free diet. So coeliac disease could be the underlying cause of idiopathic intussusception more often than previously thought and intussusception should be suspected in patients with known coeliac disease presenting with abdominal pain. (Acta gastro-enterol. belg., 2016, 79, 000-000).

Idiopathic megaoesophagus and intermittent gastro-oesophageal intussusception in a cat.

An eight-month-old domestic shorthair cat was presented with chronic vomiting for three months, with an acute increase in frequency during the past two days. A diagnosis of megaoesophagus was made by chest radiography. Diagnostic work-up for megaoesophagus was performed. A gastro-oesophageal intussusception was identified during endoscopy. Medical and nutritional therapy was instituted with a good response to the treatment.

Recurrent small bowel intussusceptions: an uncommon presentation of celiac disease in an Arab child.

Causes of recurrent bowel intussusception in infancy are rarely identified and uncommon causes such as gluten sensitive enteropathy are not well recognized. We report a 3 year-old Saudi girl who presented with small bowel intussusception, which was diagnosed by abdominal CT. Investigations for concomitant failure to thrive revealed celiac disease. Her small bowel intussusception resolved completely when she was placed on a gluten free diet.

Outcome and management of patients with large rectoanal intussusception.

OBJECTIVES: Rectoanal intussusception is the funnel-shaped infolding of the rectum, which occurs during evacuation. The aims of this study were to evaluate the risk of full thickness rectal prolapse during follow-up of patients with large rectoanal intussusception, and whether therapy improved functional outcome. METHODS: Between September 1988 and July 1997, patients diagnosed with a large rectoanal intussusception by cinedefecography (intussusception > or = 10 mm, extending into the anal canal) were retrospectively evaluated. Patients with full thickness rectal prolapse on physical examination or cinedefecography were excluded, as were patients with colonic inertia or a history of surgery for rectal prolapse. The patients were divided into three groups according to the treatment received: group I, conservative dietary therapy; group II, biofeedback; and group III, surgery. Outcomes were obtained by postal questionnaires or telephone interviews. Parameters included age, gender, past medical and surgical history, change of bowel habits, fecal incontinence score, and development of full thickness rectal prolapse. RESULTS: Of the 63 patients, 18 were excluded (seven patients had confirmed full thickness rectal prolapse, four had previous surgery for rectal prolapse, three had colonic inertia, and four died). Follow-up data were obtained in 36 (80%) of the remaining 45 patients. The mean follow-up of this group was 45 months (range, 12-118 months). There were 34 women and two men, with a mean age of 72.4 yr (range, 37-91 yr). The mean size of the intussusception was 2.2 cm (range, 1.0-5.0 cm). The patients were classified as follows: group I, 13 patients (36.1%); group II, 13 patients (36.1%); and group III, 10 patients (27.8%). Subjectively, symptoms improved in five (38.5%), four (30.8%), and six (60.0%) patients in the three groups (p > 0.05). Among the patients with constipation, the decrease in numbers of assisted bowel movements per week (time of diagnosis to present) was significantly greater in group II compared to group 1 (8.1+/-2.8 vs 0.8+/-0.5, respectively, p = 0.004). Among the patients with incontinence, incontinence scores improved more in group II as compared to either group I or group III (time of diagnosis to present, 3.7+/-4.2 to 1.1+/-5.4 vs 1.4+/-2.2, respectively, p > 0.05). Six patients (two in group I, three in group II, and one in group III) had the sensation of rectal prolapse on evacuation; however, only one patient in group I developed full thickness rectal prolapse. CONCLUSIONS: This study demonstrated that the risk of full thickness rectal prolapse developing in patients medically treated for large intussusception is very small (1/26, 3.8%). Moreover, biofeedback is beneficial to improve the symptoms of both constipation and incontinence in these patients. Therefore, biofeedback should be considered as the initial therapy of choice for large rectoanal intussusception.