Association between Celiac Disease and Intussusceptions in Children: Two Case Reports and Literature Review
A 5-year-old girl was hospitalized because of abdominal distention and severe bilious vomiting. Her defecation was not changed but was loose. She had history of anorexia, poor weight gain and abdominal distention since infancy but had not have visited previously. She was toxic, febrile and cachectic with weight of 12 kg (<3% weight percentile for age for girls) and height of 96 cm (<5% height percentile for age for girls). Her lung was normal but heart was tachycardic. Abdomen was distended with hyperactive bowel sound, and diffuse tenderness was noted on palpation. Her abdominal X-ray revealed air-fluid levels, indicative of bowel obstruction. Abdominal ultrasonography revealed gas distention of bowel loops and reductable transient intussusceptions with donuts appearance on the right side of the abdomen (). Nasogastric tube was inserted. After three days of serum therapy and administration of antibiotics, vomiting had stopped and abdominal distention decreased gradually. Laboratory tests revealed leukocytosis (18,400/mm3) with polyneucleosis (11,800/mm3), anemia (hemoglobin, 8.4 g/dL), normal serum electrolytes, tTG IgA >800 U/mL, and tTG IgG >200 U/mL. Diagnosis of celiac disease was confirmed with endoscopic duodenal biopsies, showing histopathology of marsh III (). After six months GFD, she had got good appetite and gained 6 kg of weight and her distention was resolved near completely.