Intestinal Intussusception

Abstract

To identify and propose unusual presentations of a common disease entity. A 36 year old Irish male was referred to the Crohn's and Colitis Center of NJ for evaluation of a jejunal intussusception found on CT scan. We were consulted to rule out Crohn's disease as the cause of the intussusception. He had a history of seminoma, and was status post orchiectomy. His oncologist felt that the lesion was unrelated to the seminoma. The patient denied fevers, chills or night sweats. There was no history of diarrhea, blood per rectum or anemia. There was no family history of inflammatory bowel disease. The patient did note recent visual field defects, arthralgias, and a 15 pound weight loss. There was no travel history. Physical examination revealed temporal wasting. Cardiac, pulmonary, abdominal and skin examination was normal. A small bowel follow through was ordered and was normal. With this constellation of symptoms and negative imaging studies, a diagnosis of Crohn's disease was felt to be unlikely. The patient continued to have weight loss. A follow up CT scan revealed mesenteric adenopathy. An MRI of the brain revealed bilateral optic nerve hypoplasia. Endoscopy was performed to rule out occult celiac disease. At the time of endoscopy an area of questionable jejunal prominence was noted and biopsied. A celiac disease antibody profile was ordered concurrently. Biopsy results revealed subtotal villous atrophy. Tissue transglutaminase antibodies and antigliadin antibodies were all noted to be highly positive. The patient started a gluten free diet. Six weeks after instituting the gluten free diet the patient has gained weight, his arthralgias have improved, and he feels better. His optic nerve hypoplasia has not progressed and is believed to be unrelated to celiac disease. Celiac disease is a common disease entity. The most common presentation is occult anemia. Weight loss and diarrhea are other clues to this disease process. Jejunal intussusception seen at CT may be an early clue that a patient has celiac disease. Enteroenteric intussusceptions are usually nonneoplastic entities. Celiac disease is an example of a functional disturbance that may cause intussusception without gross mural abnormality. Gluten sensitivity causes muscular flaccidity which may lead to a transient intussusception.