Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
24 (
2
); 136-137
doi:
10.4103/0971-4065.127930

Small bowel intussusception in an adult with nephrotic syndrome

Department of Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
Department of Rheumatology and Clinical Immunology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
Address for correspondence: Dr. Sumantro Mondal, Doctor's Hostel, 242 A J C Bose Road, Kolkata - 700 020, West Bengal, India. E-mail: drmsumantro@gmail.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

A 27-year-old male was admitted to our hospital with acute colicky pain abdomen, abdominal distention for 4 days with no passage of stool for the same duration. He also had swelling of bilateral lower limbs for a week. Examination showed mild pallor, tachycardia and blood pressure of 80/60 mmHg. Abdomen was distended and tender with sluggish peristaltic sounds. Patient had a past history of nephrotic syndrome during childhood for which he was treated with steroids and he had frequent relapses. He was treated with cyclophosphamide at the age of 17 years, after which he remained asymptomatic. The straight X-ray abdomen showed distended small bowel loops. He was managed conservatively with intravenous crystalloids, Ryle's tube aspiration and antibiotics. He had Hemoglobin of 10.9 g/dl, normal liver function test and urea: 53 mg/dl, creatinine: 1.9 mg/dl. Blood triglyceride and cholesterol level were: 872 mg/dl and 345 mg/dl respectively. His serum albumin was: 1.8 g/dl and urine for Albumin creatinine ratio was 1072 mg/dl. Serum amylase and lipase were within the normal limits. Autoimmune serology was negative and complement level was normal. Ultrasonography showed distended small bowel loops, normal pancreas, normal renal size and echotexture and normal renal vein. The findings were suggestive of intussussception of the bowel with a typical “crescent in doughnut” sign [Figure 1]. This is formed by hypoechoiec intussusceptum surrounding hyperechoiec mesenteric fat.[1] Percutaneous renal biopsy demonstrated features consistent with minimal change disease. Patient improved with conservative management.

Figure 1
Transverse view of intussusception in ultrasonography producing the “crescent in doughnut” sign (white arrow)

Nephrotic syndrome may be associated with gastrointestinal disturbances. The differential diagnosis considered in this setting is renal vein thrombosis, peptic ulcer disease and sub-acute bowel obstruction. Ultrasonography is the diagnostic tool of choice to detect intussusception. In our case, presence of hypertriglyceridemia initially tempted us to make pancreatitis as a provisional diagnosis. Intussusception has been reported frequently in pediatric population, but it is uncommon in adults with nephrotic syndrome. Intussusception of small bowel in adult with nephrotic syndrome presenting with swollen limbs and effusion has been reported before.[2] Intussusception in nephrotic syndrome may be due to incoordinated gut motility and bowel wall edema. As seen in our patient, intussusception resolves with treatment of the underlying nephrotic syndrome without the need for any intervention.[34] Reversal of intussusception associated with nephrotic syndrome by infusion of albumin has been reported in pediatric patients.[5] In spite of good prognosis of childhood minimal change disease, approximately 20% continue to relapse 10 years after diagnosis, as seen in our case.

References

  1. , , , . Intussusception: US findings with pathologic correlation – The crescent-in-doughnut sign. Radiology. 1996;199:688-92.
    [Google Scholar]
  2. , , , , , . Intussusception of the small bowel in an adult associated with nephrotic syndrome. NDT Plus. 2010;3:505-12.
    [Google Scholar]
  3. , , , , , , . Intussusception in children: Current concepts in diagnosis and enema reduction. Radiographics. 1999;19:299-319.
    [Google Scholar]
  4. , , , , . Current radiological management of intussusception in children. Eur Radiol. 2007;17:2411-21.
    [Google Scholar]
  5. , , , , , , . The reversal of intussusception associated with nephrotic syndrome by infusion of albumin. Pediatr Nephrol. 2009;24:421-2.
    [Google Scholar]

    Fulltext Views
    46

    PDF downloads
    35
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections