F. Bernard

Invagination intestinale aiguë révélant une maladie cœliaque : à propos d’un cas et revue de la littérature

INTRODUCTION Acute bowel intussusception is a rare manifestation in adult, which mainly involves the small intestine. Celiac disease is a frequent small bowel disease that is largely undiagnosed in adults. We report a patient in whom spontaneously regressive small bowel intussusception was the presenting manifestation of celiac disease. CASE REPORT A 40-year-old man was admitted for a right-sided iliac abdominal pain related to a small bowel intussusception. Laparotomy ruled out a digestive tumor. Persistence of diffuse abdominal pain associated with progressive and unexplained weight loss for several months led to the diagnosis of celiac disease, which was confirmed by the presence of specific serum autoantibodies and histological duodenal villous atrophy. CONCLUSION The association between small bowel intussusception and celiac disease does not seem to be fortuitous. Based on this report and the literature review, we suggest that celiac disease can favour small bowel intussusception, even in adulthood. Therefore, diagnosis of celiac disease must be discussed in the presence of unexplained intussusception.

Management of Autoimmune Systemic Diseases in the Intensive Care Unit

The diagnosis of an autoimmune systemic disease (SD) and/or its management in the intensive care unit (ICU) is dependent on dialogue between the intensivist and specialists in these diseases. However, some clinical (syndromic associations) or biological signs should lead the intensivist to suspect these diseases. Several biological or histological investigations can be rapidly performed in the ICU to confirm the diagnosis. Both treatments of a potential flare-up of the suspected disease and a concurrent infectious complication need often to be started simultaneously. While waiting for the effects of these specific treatments, supportive treatment may include the initiation of non-invasive ventilation or, in severe specified cases, invasive mechanical ventilation with extra-corporeal supports like Renal Replacement Therapy (RRT) and extra-corporeal membrane oxygenation (ECMO). Referent centers should be asked for validation of the therapeutic options, especially when some drugs are used off-label for these severe patients. An integrative diagnostic and therapeutic approach is proposed to guide the intensivist in this complex management.

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An asymptomatic thrombocytopenia in a 66-year-old man B. Granel a,∗, F. Bernard a, P. Rossi a, D. Bagneres a, A.-L. Demoux a, S. Bonin-Guillaume a, D. Arnoux b, G. Sebahoun b, K. Pouymayou c, Y. Frances a, M. Khellaf d a Service de médecine interne, hôpital Nord, AP–HM, chemin des Bourrely, 13915 Marseille cedex 15, France b Laboratoire d’hématologie, hôpital Nord, AP–HM, chemin des Bourrely, 13915 Marseille cedex 15, France c Centre d’exploration de l’hémostase et thrombose (CEHT), hôpital de La-Timone, AP–HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France d Service de médecine interne, CHU Henri-Mondor, 51, avenue de Lattre-de-Tassigny, 94010 Créteil, France