Recurrent Intestinal Invagination : Atypical Manifestation of Coeliac Disease

Background : Intestinal invagination usually presents accutely in infants under 2years after gastro-intestinal tract infection, when it occurs in older children or with chronic symptomatology , secondary causes must be ruled out such as polips, tumours or rarely, coeliac disease.

Objective: We present here an atypical case of recurrent invagination in a 9 years old girl wih malnutrition.

Methods: Clinical report of a case, clinical and laboratory data have been collected.

Results: 9 years old girl who lived in Morocco with her mother with low socioeconomic status. She used to have pica, failure to thrive and episodes of acute abdominal pain wih distension and vomits. She had no access to healthcare. She was transfered to emergency department in Spain hospital because of abdominal pain, vomiting and bloody diarrhea with ultrasound diagnosis of invagination. During surgery enlarged intestinal lymph nodes were seen and removed for biopsy and the invagination was reducted. Several malnutrition was noticed, with body mass index , Waterlow and Shukla index very low for his age; she presented with no eyelashes and eyebrows thinning (Picture1). In blood test, iron deficiency, low leves of vitamine A, E, B12, zinc and folic acid were measured, and very high levels of anti-transglutaminase antiboides IgA (>128 U/ml). Duodenal biopsy was carried out and resulted in marked atrophy of villi and increased criptes (Marsh IIIb). After gluten-free diet the patient did not have invagination any more and gained weight.

Conclusion: Although coeliac disease is well-known and easily diagnosed in developed-countries, atypical and severe manifestations can occur when there is no access to medical services in non-developed countries.