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Intestinal malrotation is the incomplete rotation of the midgut during embryogenesis. The reported prevalence is 1 in 500 live births, however some studies report a prevalence as high as 1% of the population1, 2. Traditionally it is though as a disease of the pediatric population presenting as bilious emesis during the first year of life but can present with different symptoms even in adulthood. Presentation in older populations tends to be atypical, chronic abdominal pain, nausea and diarrhea being the most commonly reported symptoms 3. However, as these symptoms accompany almost all-gastrointestinal pathology it is difficult to determine if abnormalities of rotation and fixation of the intestine are the cause for the symptoms in a given patient given its relative rarity. It therefore is important to have a high index of suspicion in patients with non-specific gastrointestinal symptoms. We report laparoscopic management of a patient with abnormal rotation/fixation who was treated for many years as celiac disease (CD). Celiac disease is an immune mediated systemic disorder elicited by gluten in genetically susceptible individuals4. It can present as chronic abdominal pain, chronic diarrhea, failure to thrive, weight loss, stunted growth, distention and fatigue. His symptoms immediately resolved after surgery.
Autoimmune polyglandular syndromes (APS) are a diverse group of clinical conditions characterized by loss of immune tolerance in various tissues. This condition can be diagnosed in childhood or adulthood, with changes in the components of the disease throughout life. Here, an unusual case of association between immune-mediated diseases will be addressed: Myasthenia Gravis, Systemic Lupus Erythematosus, and Celiac Disease. In this patient, each disease was expressed over time. Finally, we assume that this is a clinical form of APS type IV, due to the lack of thyroid involvement to date.