Intussusception is commonly seen in children but is rare in adults and represents only 5% of all intussusceptions causing 1% of intestinal obstructions. More than 50% of these intussusceptions in adults are due to intestinal neoplasms, including malignant lymphoma, e.g., Burkitt lymphoma. These lymphomas are more common in human immunodeficiency virus (HIV)-positive patients than in the general population. We present a case of a young male who was diagnosed with HIV when he developed intestinal obstruction and intussusception secondary to Burkitt lymphoma. He was managed with surgical resection followed by chemotherapy and antiretroviral treatment. HIV patients presenting with acute abdomen pose a diagnostic challenge to clinicians due to a wide range of differential diagnoses including inflammatory, infectious and neoplastic conditions. In a young HIV patient presenting with acute abdomen, intussusception caused by Burkitt lymphoma should be considered in the differential.

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Rationale: Pressure support ventilation (PSV) is often used for spontaneous breathing trials (SBT) to test patient's readiness for liberation from mechanical ventilation (MV). It is theoretically possible that PSV occasionally increases work of breathing or makes patients uncomfortable, leading to apparent SBT failure. Institutionally, we have had patients fail SBT with "high" levels of PSV, only to be successfully extubated after T-piece trial. We sought to identify these cases and analyze for risks of factitious PSV-failure. Methods: Electronic records of 1076 patient-extubations (22 months in a 350-bed community teaching hospital) were reviewed. Medically ill adults, ventilated >48 h, who failed PSV³10 cmH2O but were extubated successfully (>48 h) same-day after a successful T-piece (or on trach-collar for >2 H) were examined in greater detail. Demographic, historical and physiologic data were gathered. Results: Out of 1076 extubation attempts, 546 (50.7%) were medical patients not extubated for comfort-only care. Four (4) patients, averaging 71 y (range: 48-89 y), and 9.3 d (4-17 d) of MV failed (Vt<300 ml, ³30/min, distress) SBTs with mean PSV 12.5 cmH20 (10-15 cmH2O; PEEP=5 cmH2O). On the same day, they passed a brief (10-120 minute) T-piece trial and were successfully extubated. A 5 th patient with ARDS failed PS=22 cmH2O on her 45 day (after >7 d of failed PSV), but same-day breathed 6 H on trach collar. Trach-collar th trials were lengthened until complete liberation. Conclusion: PSV may occasionally increase work of breathing (relative to unassisted breathing) or may be uncomfortable for some patients, thereby contributing to SBT task "failure." This report likely underestimates the frequency of this phenomenon because patients who fail PSV>10 rarely perform same-day T-piece trials in our ICU. Nonetheless, insofar as some (³1%) medical patients are thus bound to the ventilator, the risks of prolonged invasive ventilation may warrant consideration of this factitious respiratory failure, obviated if T-piece SBTs are also attempted in PSV "failures". This abstract is funded by: NoneAm J Respir Crit Care Med