S6175 Adult With Multiple Simultaneous Enteroenteric Intussusceptions as a Presenting Feature of Celiac Disease

Introduction: Intussusception, a condition where 1 segment of the intestine telescopes into another, is rare in adults, accounting for only 5% of cases. Unlike children, adult presentations are nonspecific, typically including nausea, vomiting, or abdominal pain. Most adult cases are due to a pathological lead point such as carcinoma, polyp, or diverticulum. We present a case of multiple simultaneous intussusceptions as an initial presentation of celiac disease. Case Description/Methods: A 28-year-old woman presented with acute right flank pain radiating to the groin, associated with nausea. Urinalysis showed hematuria; computed tomography imaging revealed right nephrolithiasis and 3 areas of non-obstructing enteroenteric intussusceptions in the jejunum and ileum. She denied vomiting, diarrhea, or obstipation, though she continued to experience mild diffuse abdominal pain. Physical exam was unremarkable. Push enteroscopy revealed abnormal duodenal mucosa with mosaic pattern, and scalloping of the duodenal and jejunal folds. Serum tissue transglutaminase was elevated (>100 U/mL). Capsule endoscopy showed no focal lesions. Duodenal biopsies confirmed Celiac disease. A gluten-free diet was initiated, and the patient became asymptomatic. Nine months later, her tissue transglutaminase level dropped to 10 U/mL. Discussion: Celiac disease affects approximately 0.6-1% of the global population. The “celiac iceberg” model explains its underdiagnosis, with most patients presenting with silent or atypical symptoms. While classic symptoms include diarrhea and weight loss, some patients manifest with extraintestinal symptoms such as iron deficiency, or, rarely, intussusception. In a Swedish population-based study, patients with established celiac disease had a modestly increased risk of intussusception (HR = 1.95). Proposed mechanisms include motility abnormalities induced by malabsorption. Diagnosing celiac disease is essential in determining management, as intussusception in this context often resolves without surgical intervention. In our case, dietary modification alone led to clinical and serologic improvement.