Location of Intussusception in Adult Celiac Disease
Intussusception in adults with celiac disease occurs throughout the small intestine without a specific predilection site, though the jejunum is most commonly involved when identified on imaging studies. 1
Evidence from Clinical Studies
The largest adult celiac disease cohort examining intussusception found that among 880 celiac patients, 14 developed intussusception detected by CT, capsule endoscopy, or barium studies, but the study did not identify a consistent anatomical location pattern. 1 The intussusceptions were distributed throughout the small bowel rather than clustering in one specific region. 1
Historical radiological studies from 1978 documented transient non-obstructive intussusception in approximately 20% of adult celiac patients undergoing small bowel meal examination, again without specifying a predominant anatomical site. 2 These were described as transient and non-obstructive, occurring throughout the small intestine. 2
Clinical Context and Mechanism
The lack of a specific anatomical predilection in celiac disease-associated intussusception differs fundamentally from post-bariatric surgery intussusception, where retrograde jejuno-jejunal intussusception occurs predictably at the entero-enterostomy. 3 In celiac disease, the mechanism involves:
- Altered intestinal motility from chronic inflammation 3
- Severe villous atrophy creating lead points - 10 of 14 patients in the largest series had subtotal or total villous atrophy 1
- Absence of surgical anastomoses or fixed anatomical landmarks that would localize the process 1
Critical Clinical Implications
When intussusception is detected in an adult celiac patient, adenocarcinoma must be excluded regardless of location. 1 In the Mayo Clinic series, 2 of 14 patients had lead-point intussusceptions caused by small bowel adenocarcinoma. 1
Intussusception may be the initial presentation of celiac disease in 57% of cases, occurring before diagnosis, and is strongly associated with abdominal pain (78% of patients). 1 This emphasizes that celiac disease should be considered when adult intussusception is encountered at any small bowel location. 1
Diagnostic Approach
The British Society of Gastroenterology guidelines emphasize that celiac disease primarily affects the small bowel with villous atrophy most prominent in the duodenum and proximal jejunum, though lesions can be patchy. 3 However, intussusception as a complication does not follow this proximal-to-distal gradient of mucosal damage. 1
The majority of patients (6 of 9 who adhered to a gluten-free diet) had no recurrence of intussusception after strict dietary adherence, suggesting that treating the underlying celiac disease addresses the pathophysiologic mechanism regardless of anatomical location. 1