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Perihepatic lesions mimicking primary liver tumors.

cause of symptoms other than diarrhea or iron deficiency [2]. In light of this information it is important to consider celiac in patients with atypical symptoms. In the 1960s and 1970s, when small bowel barium meals were routinely used to evaluate patients with celiac disease, intussusception was reported in up to 20% of cases [3]. Outside the radiologic field, however, there is a lack of awareness of this association. Only a few case reports have been published, most of them in the pediatric literature. In adults, in 70±90% of cases, intussusception is secondary to an identifiable lead point such as a polyp, metastatic deposit, or Meckel's diverticulum [1]. Although adult intussusception at presentation can be acute, it is usually subacute or chronic. A longer mean duration of symptoms has been reported in benign lesions than in malignant lesions and in enteric compared to colonic lesions [1]. Gastrointestinal dysmotility and intestinal wall abnormalities such as edematous thickening probably cause the intussusception in untreated patients with celiac disease [4]. In adults with untreated celiac disease, muscular hypotonia and flaccidity of the small bowel may explain the nonobstructive nature of the intussusception. Adult intussusception is usually treated with surgery. Most authors agree that laparotomy is necessary, based on the likelihood of identifying a pathologic lesion. In our patient the intussusception resolved after 3±4 months of a gluten-free diet, which partly reversed the dysmotility and hypotonia of her small intestine. Our patient's liver test abnormalities also resolved after 4 months of this diet. Bardella et al. [5] recently reported that about 40% of celiac patients have hypertransaminasemia at diagnosis. The same group reported a prevalence of 9.3% of occult celiac disease in patients with unexplained hypertransaminasemia, which resolved with a gluten-free diet. In conclusion, celiac disease should be strongly suspected when intussusception is diagnosed in an adult in the absence of an overt lead point, especially when the presentation is chronic or subacute. When celiac disease is suspected and the signs and symptoms do not indicate a lifethreatening situation, conservative management should be undertaken and further investigation carried out before any surgery is planned.