Multiple intussusceptions associated with polycythemia in an anabolic steroid abuser, a case report and literature review

Abstract

Intussusceptions are generally associated with mechanical lead points or localized inflammation that function as foci for intestinal telescoping. We present the case of a patient whose abuse of anabolic steroids resulted in the development of multiple simultaneous intussusceptions. Our patient had no additional identifiable risk factors for intussusception. Consistent with previous reports, corticosteroid induced polycythemia and its consequent hyperviscosity led to intravascular sludging and mesenteric ischemia with associated bowel wall thickening. The localized intestinal induration then served as mechanical foci for intussusception. Due to the illicit nature of anabolic androgenic steroid (AAS) abuse, the physiologic effects of supraphysiologic doses are sparsely reported and poorly understood. The scope of AAS abuse and its consequences are likely under-reported and under-recognized within the medical community. Our case presented a unique diagnostic and therapeutic challenge with which we aim to increasing awareness and clinical suspicion for AAS among healthcare personnel.

Multiple Small Bowel Intussusceptions in the Setting of Anabolic Steroid Use

“…This theory was first described by Cavanaugh et al in 2015 and again by De Robles et al in 2020 and Goyal et al in 2020. 3 4 5…”

“…This theory was first described by Cavanaugh et al in 2015 and again by De Robles et al in 2020 and Goyal et al in 2020. [3][4][5] AAS use is a growing public health concern, with significantly increased use among both professional and amateur athletes being reported throughout the United Kingdom and United States. McVeigh and Begley estimate the prevalence of AAS use in the United Kingdom has risen from 1.88 per 1,000 population in 1995 to 5.72 per 1,000 population in 2015.…”

“…He did, however, report a history of anabolic steroid use; this has been postulated as a cause of adult intussusception, and was first described by Cavanagh et al in 2015, and then in two further cases. [3][4][5] Given increasing rates of anabolic steroid use, in young adults presenting with small bowel intussusception without a clear mechanical cause, androgenous anabolic steroids (AAS) use should be considered as a possible etiology…”

Rare Case of Intussusception in Young Male who was Using Anabolic Steroids for Muscle Enhancement

“…There is only one case in the literature of a patient abusing anabolic steroids and found to have multiple intussusceptions (Cavanagh et al, 2015). Intussusceptions are very rare in adults and generally associated with mechanical lead points or localized inflammation secondary to a neoplasm or Irritable Bowel Diseases.…”