An increased incidence of small bowel lymphoma in patients with long-standing 
celiac sprue is well documented in the literature. Less common is the 
association of adenocarcinoma of the small intestine. We report a patient with 
celiac sprue who initially responded to a gluten-free diet. Eighteen months 
later, diarrhea, abdominal cramps, and bloating was found to have its origin in 
partial small bowel obstruction. At laparotomy, two distinct adenocarcinomas of 
the jejunum were resected. Celiac patients who initially respond to gluten 
withdrawal and subsequently suffer exacerbation while adhering to strict dietary 
therapy should be carefully evaluated for evidence of a small bowel malignancy.