Acute Abdomen in an Adult Patient with Small Bowel Intussusception, the Sole Presentation of Celiac Disease: A Case Report

Abstract

Introduction: Celiac disease, or gluten-sensitive enteropathy, is a chronic disease of the digestive tract characterized by the inability to tolerate gliadin. Characteristic presenting symptoms include chronic diarrhea, abdominal, anemia. Although common in pediatric literature, intussusception as a presenting symptom of celiac disease in adults is becoming recognized. Our case adds to this growing body of evidence. Case Report: 54-year-old female with no reported past medical history initially presented to an outside physician with complaint of sudden onset of abdominal pain and some associated nausea. CT scan of the abdomen revealed small bowel intussusception with a transition point in the proximal small bowel. Initial laboratory including hemoglobin was unremarkable. The patient underwent an endoscopy, which revealed diffuse moderately scalloped mucosa in the first through the third part of the duodenum (Figure 1). Biopsies taken, as well as serologic testing, subsequently confirmed the diagnosis of celiac disease. The patient was advised to consume a gluten-free diet and to follow with a gastroenterologist as an outpatient. She is currently asymptomatic.Figure 1Discussion: Celiac disease is a disease that affects 1% of the population in the United States. Celiac disease can present infrequently as an acute abdomen. Approximately 3-10% of patients with celiac disease are diagnosed with acute abdomen. The most common causes of acute abdomen are intestinal perforation, complication related to lymphoma, volvulus and intussusception. In a recent study of patients with intussusceptions seen on imaging only, approximately 0.3% associated with a diagnosis and of these only three patients had confirmed celiac disease as a cause. Literature review of intussusception and celiac disease reveals several reports. However, these patients had additional symptoms and lab abnormalities. We report here acute abdomen as the only manifestation of celiac-related intussusception. Our case suggests that adult patients presenting with idiopathic intussusception should have a work-up for celiac disease.