Abstract

IntroductionAlthough 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.Case presentationA 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.ConclusionHuman 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.

Highlights

  • A common cause of intestinal obstruction in children, intussusception is a rare event in the adult population living in temperate regions

  • Human immunodeficiency virus infection may have a silent course and gastrointestinal manifestations of the disease leading to intussusception might be the first clinical sign

  • The presence of risk factors for human immunodeficiency virus infection should be eligible for serologic tests for human immunodeficiency virus infection

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Summary

Conclusion

Though a rare cause of intestinal obstruction in adults, intussusception has been shown to have a significant correlation with HIV infection because of its association with a variety of infective and neoplastic conditions of the bowel. Patients with intestinal intussusception, and the presence of risk factors for HIV infection, should be eligible for serologic tests for HIV infection. In these patients, surgical reduction in the intussusception is well tolerated and is of clear benefit. SG made substantial contributions to the acquisition and analysis of data, was the attentant physician both during hospitalization and in the follow up visits and CAG was responsible for treatment decisions concerning the patient and he revised the manuscript for important intellectual content, FK gave final approval of the version to be published.

Introduction
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Agha FP
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