ABSTRACT
Celiac disease is an autoimmune disease that primarily affects the small intestine. Classic symptoms in children include gastrointestinal disorders as chronic diarrhea, malabsorption and failure to grow normally. It is associated with other autoimmune diseases, such as thyroiditis and diabetes mellitus type 1 . Mild or absent gastrointestinal symptoms may be found specially in older people.Celiac disease may be presented with rare but life threatening crisis. 14 years old underbuilt anemic (iron deficiency) girl with type 1 diabetes mellitus without gastrointestinal symptoms was endoscopicaly examined for clinical suspicion of Celiac disease. On endoscopic examination there was fissurization (cracked-mud ) of the mucosa of the duodenal bulb as well as descending duodenum. Pathological examination of the endosopic biopsies confirmed the diagnosis. Upper gastrointestinal endoscopy in celiac disease usually shows scalloped (indentations and erosions) blunted duodenal mucosa, visible mucosal vessels, micronodular appearance of the mucosa and mucosal fissures(cracked-mud). Duodenal biopsy shows villous blunting with intraepithelial lymphocytosis