A 49-year-old female patient with a history of irritable bowel syndrome type constipation since adolescence medicated gastritis for acute use of non-steroidal anti-inflammatory drugs (NSAIDs) in 2005 in the duodenum 2000 (high endoscopy).
In 2001, she presented with severe abdominal pain in the right iliac fossa with sudden onset, so she was hospitalized with a diagnosis of acute favorable clinical evolution, which was ruled out by abdominal ultrasound and an abdominal ultrasound.
Given the intensity of the clinical picture was carried out in a geriatric unit that showed the presence of compression at cecal level.
A CT scan of the abdomen and pelvis showed a mass in the right annex compressing the cecum.
It was decided to perform a laparoscopic exploration which finding was the presence of a dyssynthetic colon associated with a peristalsis of the small intestine and colon.
The ovaries were normal and the ovaries appeared erythematous and rigid, so a bilateral chronic salpingitis was concluded, performing a bilateral salpingectomy.
Subsequent biopsies ruled out the presence of any pathology.
The patient remained in good general condition presenting isolated episodes of discomfort and abdominal distension until August 2009, when she was hospitalized with a probable diagnosis of intestinal obstruction due to a new picture of acute and severe abdominal pain associated with dystonia.
A CT scan of the abdomen and pelvis was performed, highlighting the presence of a solid focal hepatic lesion of one cm in diameter in the segment VI, which is not probably characterized in this study, in addition to multiple areas of transient invagination in the jejunum.
The patient was treated symptomatically with good response and discharged with indication of magnetic resonance imaging for evaluation of liver injury.
This examination was carried out with the patient asymptomatic, describing two hepatic lesions of 3 and 10 mm in segment IV and VI respectively, compatible with hemangiomas, in addition to the following findings: transient invagination of a prominent lymphotendinous fold.
These signs raised the possibility of a CD.
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Serological tests were requested (positive antiendomysial antibody and antitransglutaminase antibody 67 U/ml; positive value > 25 U/ml).
Endoscopy and histology confirmed the diagnosis of CD.
The patient began treatment with gluten restriction progressing to date in good general conditions without referring digestive symptoms at present.
