Multiple small bowel intussusceptions as a feature of celiac disease

Area of Science:

• Pediatric Gastroenterology
• Radiology
• Pediatric Surgery

Background:

• Intussusception is a common cause of bowel obstruction in infants and young children.
• Celiac disease is an autoimmune disorder triggered by gluten ingestion, primarily affecting the small intestine.
• While intussusception is recognized in adults with celiac disease, its occurrence in children is infrequently documented in radiological literature.

Observation:

• A 3-year-old underweight female presented with a 6-month history of intermittent abdominal pain, distension, and vomiting.
• Abdominal X-ray showed abnormal air-fluid levels; abdominal ultrasound revealed a single small bowel intussusception.
• Contrast-enhanced CT scan identified five small bowel intussusceptions and dilated small bowel loops.

Findings:

• Elevated IgA antibodies to tissue transglutaminase confirmed celiac disease, explaining the patient's failure to thrive.
• The patient's symptoms resolved within 7 days of initiating a gluten-free diet.
• Conservative management with a gluten-free diet successfully treated the intussusception without surgical intervention.

Implications:

• This case highlights the importance of considering celiac disease in pediatric patients with recurrent intussusception, even when presenting with failure to thrive.
• Early diagnosis and dietary management of celiac disease can potentially prevent surgical intervention for intussusception in children.
• Radiologists and pediatricians should be aware of this association to facilitate timely diagnosis and appropriate treatment strategies.