Coeliac disease presenting with intraperitoneal haemorrhage

Area of Science:

• Gastroenterology
• Internal Medicine
• Hematology

Background:

• Spontaneous gastrointestinal hematomas are rare, potentially leading to hemorrhagic shock.
• Coeliac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
• CD can manifest with diverse clinical presentations, including obscure bleeding or vitamin deficiencies.

Purpose of the Study:

• To report a rare case of spontaneous mesocolonic hematoma and intraperitoneal bleed.
• To highlight the association between coeliac disease and severe coagulopathy.
• To emphasize the importance of considering coeliac disease in patients with unexplained bleeding and abnormal coagulation parameters.

Main Methods:

• Case report of a 42-year-old male patient presenting with hemorrhagic shock.
• Diagnostic workup included coagulation profile (INR), duodenal biopsy, and antibody testing (anti-reticulin).
• Therapeutic intervention involved initiating a gluten-free diet.

Main Results:

• The patient presented with hemorrhagic shock secondary to a spontaneous left mesocolonic hematoma.
• Investigations revealed elevated INR, duodenal villous atrophy, and positive anti-reticulin antibodies, indicative of coeliac disease.
• Following a gluten-free diet, the patient's duodenal biopsy and INR normalized.

Conclusions:

• Coeliac disease can present atypically with severe complications such as spontaneous hematomas and bleeding.
• Early diagnosis and management of coeliac disease with a gluten-free diet are crucial for resolving associated complications.
• This case underscores the potential for single vitamin deficiencies or malabsorption in coeliac disease to result in life-threatening events.