Multiple Small Bowel Intussusceptions Caused by Kaposi's Sarcoma: The Radiologist's Point of View.

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.[12] 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 HIV2 patient (CD4+: 7/mm3 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 1a–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),[3-5] 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)