Celiac Disease and Intussusception: A Common Association in Children

Anwaar Aldaher; Mariam Mahmoud Alali; Nouri Ourfali; Abdulwahab AlJubab; Qamar Ali; Muhammed Salman Bashir; Abdulrahman Al-Hussaini

doi:10.1097/PEC.0000000000003085

Celiac Disease and Intussusception: A Common Association in Children

Pediatr Emerg Care. 2023 Dec 13. doi: 10.1097/PEC.0000000000003085. Online ahead of print.

Authors

Anwaar Aldaher¹, Mariam Mahmoud Alali², Nouri Ourfali³, Abdulwahab AlJubab⁴, Qamar Ali⁵, Muhammed Salman Bashir⁶, Abdulrahman Al-Hussaini

Affiliations

¹ From the Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
² Pediatric Neurology Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
³ Pediatric Surgery Department, Al Azhar Hospital, Riyadh, Saudi Arabia.
⁴ Department of Pediatric Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.
⁵ Department of Pediatrics, Royal Derby Hospital, Derby, United Kingdom.
⁶ Department of Biostatistics, Research Services Administration, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.

PMID: 38086392
DOI: 10.1097/PEC.0000000000003085

Abstract

Objectives: In young childhood, intestinal intussusception (IS) is the most common cause of small bowel obstruction. A lead point such as Meckel diverticulum, polyps, tumors, enlarged lymph nodes, cystic fibrosis, and Schoenlein-Henoch purpura are recognized causes. Association between celiac disease (CD) and IS has been well recognized in adults but rarely in children. Data on causes and outcome of intussusception among Saudi children are lacking in the literature. Our objectives were to characterize the pattern of IS among Saudi children and investigate the frequency, clinical presentation, and outcome of intussusception among children with CD.

Methods: We searched the hospital's picture archiving and communications system for abdominal imaging studies (ultrasound, magnetic resonance imaging, computed tomography scan, and barium contrast studies), performed between 2008 and 2019, using "intussusception" as a search key word. The hospital medical records of the identified cases of intussusception (aged 0-14 years) were then retrospectively reviewed to collect demographic, clinical, laboratory and imaging findings, management, and outcome.

Results: During the study period, 57 cases were identified as confirmed IS (31 boys, median age 1.95 years, range 0.33-11 years). Abdominal ultrasound was the diagnostic imaging study in 93%. An underlying cause (secondary IS) could be identified in 19 (33.3%) cases: CD in 6, malignancy and Henoch-Schoenlein purpura, 5 each, and Meckel diverticulum in 3; the remaining 38 (66.6%) cases of IS were idiopathic (primary IS). The presence of hypoalbuminemia and abdominal distension were significantly associated with secondary IS as compared with primary IS (P < 0.001, P = 0.006, respectively). All of the 6 cases of IS associated with CD resolved spontaneously, but 3 were recurrent.

Conclusions: Secondary causes contributed to a large proportion of IS in our study cohort (33%) as compared with 5% to 10% in the literature. Celiac disease is an underrecognized cause of IS among children. A child with IS and hypoalbuminemia, anemia, or chronic diarrhea needs to be investigated for CD to avoid unnecessary surgery.