A 64-year-old male, with familial history of coeliac disease (daughter), recently
diagnosed (in the past 2 months) with coeliac disease himself after an episode of
diarrhea and bloating was referred to tertiary medical care for a history of 3 episodes
of obscure upper gastrointestinal bleeding through hematemesis and melena in the past
7 months. Patient started the gluten-free diet immediately after being diagnosed with
excellent compliance and clinical response. Baseline investigations revealed slight
sideropenic anemia and an elevated erythrocyte sedimentation rate. Abdominal ultrasound
revealed 8 mm mural thickening at the level of terminal ileum, with few lymph nodes
around it measuring less than 6 mm. Upper gastrointestinal (GI) endoscopy showed typical
aspect of coeliac disease: complete loss of duodenal folds with mosaic pattern. Histology
confirmed coeliac disease Marsh-Oberhuber type 3a. Computed tomographic (CT) enterography
was performed and showed the same mural thickening observed ultrasonographically situated
at the level of aortic bifurcation. The lesion presented intense contrast enhancement
in both arterial and venous phases. Radiologist opined for the colon appartenance
of the lesion because of the presence of “haustra”. In the same day, lower GI endoscopy
with ileoscopy of the last 10 cm of terminal ileum was performed and was normal. CT
enterography reinterpretation along with ultrasound reevaluation concluded that the
lesion was most probable situated at the level of jejunum. Therefore a spiral enteroscopy
was performed which found a 5 – 6 cm length stenosis in the middle jejunum, with malignant
features from where 5 biopsies were taken. Histologic examination was still in progress
at the moment of abstract submission.
