Duodenal Perforation as an Unusual Celiac Disease Presentation in Two Patients

Abstract

Celiac disease (CD) is a common genetic autoimmune disease, triggered by gluten sensitivity. CD can present at any age in both children and adults after consuming gluten containing diet. Presentation of CD varies widely. There is paucity of data regarding emergency presentation of CD in the literature. Severe abdominal pain and gastric obstructions have been reported, but there are no reports of spontaneous duodenal perforation as of CD presentation. We searched the Mayo Clinic electronic medical records, between 1997-2011 for any cases of association between celiac disease and duodenal perforation. We identified two patients (7 yo M, 31 yo F). First patient presented with gastric obstruction due to duodenal perforation. Gastroduodenostomy was performed and elevated celiac serology few years after his initial presentation lead to the diagnosis of CD. Second patient had sudden acute RUQ abdominal pain and was found to have sign of visceral perforation on abdominal CT. Evaluation for anemia and rectal bleeding few years later showed positive CD markers that was confirmed by histology. Spontaneous duodenal perforation can be the presenting sign of CD. Celiac serology testing may be considered in patients presenting with spontaneous duodenal perforation.