Small bowel infarction in a patient with coeliac disease

A 40 year old man was admitted with a four week history of intractable diarrhoea and abdominal pain. A clinical diagnosis of inflammatory bowel disease was supported by biopsies of colonic mucosa. There was no response to Mesalazine and over 12 days the patient became critically ill with diarrhoea, hypovolaemia, and peritonism. A laparotomy was performed and 130 cm of infarcted ileum was resected. Extensive investigations excluded thrombophilia and echocardiography excluded intracardiac thrombus. Postoperatively the patient continued to have diarrhoea and he was diagnosed with coeliac disease on the basis of positive antiendomysial and antitissue transglutaminase autoantibodies and duodenal histology. Although there is no proof that mesenteric infarction occurred as a direct consequence of coeliac disease, clinicians should be aware of this possibility.