Diagnosis of Celiac disease at laparoscopy

In: Celiac disease

26 Aug 2012

celiac disease

The clinical presentation of celiac includes several common and a number of unusual presentations. The present case falls into the latter category, and the authors discuss the features that highlight aspects of the pathophysiology of this disease that have received little attention in the literature.

A 27-year-old woman with a 10-year history of uncomplicated type 1 diabetes was referred for a tubal ligation. Evaluation in the preoperative assessment clinic revealed gastroesophageal reflux for which she took Tums (GlaxoSmithKline, USA); no other gastrointestinal symptoms were noted. Abdominal examination was normal.

At laparoscopy the small bowel was found to be grossly abnormal with circumferential erythema, dilated blood vessels and lacteals (Figure 1). Interoperative consultation with general surgery was obtained and she was subsequently referred for gastroenterology consultation.

Appearance of small bowel

Figure 1) Appearance of small bowel from a video recording taken at laparoscopy, demonstrating vascular and lymphatic dilatation

Further functional inquiry confirmed the use of Tums for vague abdominal discomfort. She had a tendency to constipation and reported occasional episodes of abdominal bloating and borborygmi. Her weight had fallen by 6.5 kg over the previous year despite a normal food intake.
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