Multi-segment intussusception in infant with suspected celiac crisis: A case report

Celiac crisis (CC) is a rare, life-threatening manifestation of often undiagnosed or inadequately treated celiac disease (CeD). In infants with nonclassical presentations of CeD, timely diagnosis can be challenging but critical to reducing end-organ damage and serious complications, such as CC. We report a case of a 14-month-old infant presenting with 1 month of inappetence, malnutrition, and abdominal pain in the absence of diarrhea. The infant was found to have extraintestinal manifestations suggestive of CC, such as electrolyte derangement, hypoalbuminemia, and neurologic dysfunction. However, the infant also presented with unusual multi-segment small bowel-small bowel intussusception prior to the diagnosis of CeD. Intussusception may reflect severe small bowel enteropathy in CeD. Hypoalbuminemia and intestinal edema seen in CC may further precipitate small bowel-small bowel intussusception. Future studies should clarify distinct phenotypes of infantile-onset CeD associated with more severe CC.