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LETTER TO EDITOR  
Year : 2011  |  Volume : 3  |  Issue : 1  |  Page : 96-97
Multiple small bowel intussusceptions caused by Kaposi's sarcoma: The radiologist's point of view


Department of Radiology, Hospital Garcia de Orta, Lisbon, Portugal

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Date of Web Publication4-Mar-2011
 

How to cite this article:
Afonso P D, Lourenço R. Multiple small bowel intussusceptions caused by Kaposi's sarcoma: The radiologist's point of view. J Global Infect Dis 2011;3:96-7

How to cite this URL:
Afonso P D, Lourenço R. Multiple small bowel intussusceptions caused by Kaposi's sarcoma: The radiologist's point of view. J Global Infect Dis [serial online] 2011 [cited 2019 Aug 24];3:96-7. Available from: http://www.jgid.org/text.asp?2011/3/1/96/77307


Sir,

HIV patients are at high risk for conditions that predispose to intussusception, like lymphomas and infections of the GI tract. Therefore, whenever these patients have acute and unspecific abdominal complaints, the diagnosis of intussusception should also be considered. [1],[2] Computed tomography (CT) is a very useful imaging method for diagnosis of intussusception and can be quite helpful in this group of patients. We present a 43-year-old HIV 2 patient (CD4 + : 7/mm 3 and undetectable viral load) with known cutaneous Kaposi's sarcoma for a year, admitted to our hospital with an acute abdominal pain. CT images revealed a typical bowel-within-bowel appearance [[Figure 1]a-c], with two adjacent bowel walls of the outer intussuscipiens (double arrows) and the inner intussusceptum (arrow), associated with invaginated mesenteric fat and vessels (solid arrowhead), [3],[4],[5] suggesting multiple small bowel intussusceptions probably caused by Kaposi's sarcoma. This was later confirmed by surgical specimens (enterectomy with biopsies disclosed sixteen tumoral lesions due to Kaposi's sarcoma in the whole extension of the small bowel). So whenever you see a target-like image in a CT abdominal scan, look for the radiologist and keep in mind intussusception!
Figure 1: (a-c) Axial CT scans of the abdomen showing multiple intussusceptions (asterisks) in the jejunum and ileum caused by Kaposi's sarcoma; (a) Image shows round mass with a target pattern ("bowel-within-bowel appearance") due to adjacent bowel walls of the outer intussuscipiens (double arrows) and the inner intussusceptum (arrow). Inside, a half-moon-shaped hypodense area of fat density representing mesenteric fat, plus vessels (solid arrowhead). This pattern is observed when axis of intussusception is perpendicular to CT beam. (b, c) Images show several enteroenteric intussusception forming several loops with the abdomen and pelvis. In some, a lead point corresponding to Kaposi's submucosal masses is seen (open arrowhead)

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   References Top

1.Wetter A, Schaudt A, Lehnert T, Schmidt-Matthiesen A, Jacobi V, Vogl TJ. Small-bowel intussusception as a rare differential diagnosis in HIV-positive patients with acute abdominal pain. Eur Radiol 2006;16:952-3.   Back to cited text no. 1
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2.Farrier J, Dinerman C, Hoyt DB, Coimbra R. Intestinal lymphoma causing intussusception in HIV(+) patient: A rare presentation. Curr Surg 2004;61:386-9.   Back to cited text no. 2
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3.Kim YH, Blake MA, Harisinghani MG, Archer-Arroyo K, Hahn PF, Pitman MB, et al. Adult Intestinal Intussusception: CT appearances and identification of a causative lead point. Radiographics 2006;26:733-44.   Back to cited text no. 3
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4.Irish MS, Shellnut J. Intussusception: Surgical Perspective eMedicine Clinical Reference; 2006.   Back to cited text no. 4
    
5.Lvoff N, Breiman RS, Coakley FV, Lu Y, Warren RS. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003;227:68-72.  Back to cited text no. 5
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Correspondence Address:
P Diana Afonso
Department of Radiology, Hospital Garcia de Orta, Lisbon
Portugal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.77307

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