Unusual presentation of eosinophilic enteritis as multiple strictures of small intestine (original) (raw)
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Eosinophilic enteritis with enteroliths: A diagnostic dilemma
Introduction and importance: Eosinophilic gastroenteritis (EG) is a rare disease, characterized by eosinophilic infiltration of different layers of intestinal wall. Thus having a wide spectrum of presentation leading to diagnostic dilemma. Case presentation: We report a case of 55 years old female who presented with pain in abdomen, constipation, vomiting off and on with passage of stools on alternate days since 6 months. Plain radiographs showed radioopaque densities in abdomen. Contrast enhanced computed tomography (CECT) of abdomen showed Ileal stricture with dilated proximal bowel loops with enteroliths. Exploratory laparotomy confirmed ileal stricture with thickening of the mesentery and an ileal diverticulum. Resection of ileal stricture was performed. The resected segment contained seven hard, black enteroliths. Histopathology of the resected specimen confirmed EG. Stone analysis showed dense faecal matter with bile salts. Clinical discussion: EG leads to symptoms ranging from vomiting, abdominal pain, diarrhoea, blood loss in stools, anaemia to malabsorption resulting in diagnostic dilemma. It may cause gastrointestinal obstructive symptoms secondary to stricture, depending upon the predominant layer involved. Conclusion: The differential diagnosis of EG should always be considered when dealing with gastroenteritis presenting with radio-opaque densities in abdomen.
Eosinophilic enteritis: a rare cause of diarrhoea
BMJ case reports, 2013
We report a case of a healthy young man presenting with 1-week history of diarrhoea, acute abdominal pain and weight loss. Laboratory investigation showed very high peripheral eosinophils levels. After exclusion of the other causes of eosinophilia, a histological bowel sample analysis revealed marked eosinophilic infiltration of a small bowel mucosal layer which confirmed the suspicion of eosinophilic enteritis. Unlike most of the described cases, this patient did not require any specific treatment. Eosinophilic gastroenteritis is a rare and heterogeneous disease that is probably underdiagnosed in clinical practice because it requires a high degree of suspicion and an endoscopic biopsy for definite diagnosis.
Unusual presentations of eosinophilic gastroenteritis: Two case reports
The Turkish Journal of Gastroenterology, 2014
Eosinophilic gastroenteritis is a rare disease that is characterized by eosinophil infiltration in one or multiple segments of the gastrointestinal tract. The etiology of this condition remains unknown. Eosinophilic gastroenteritis has heterogeneous clinical manifestations that depend upon the location and depth of infiltration in the gastrointestinal tract, and eosinophilia may or may not be present. This article reports two cases of eosinophilic gastroenteritis. The first is that of a 49-year-old woman with abdominal pain, ascites, eosinophilia, and a history of asthma. The second case is that of a 69-year-old male with a history of loss of appetite, belching, postprandial fullness, heartburn, and a 5-kilogram weight loss over a period of 9 months; ultimately, the patient was diagnosed with a gastric outlet obstruction due to pyloric stenosis. The rare character of eosinophilic gastroenteritis and its varied clinical presentations often lead to delayed diagnoses and complications. Case reports may help to disseminate knowledge about the disease, thereby increasing the likelihood of early diagnosis and intervention to prevent complications.
An Unusual Presentation of Eosinophilic Gastroenteritis: Case Report and Literature Review
The Open Gastroenterology Journal, 2012
Eosinophilic gastroenteritis [EGE] is a rare disease of the gastrointestinal tract characterized by eosinophilic infiltration of the bowel wall and variable gastrointestinal manifestation. The signs and symptoms of EGE are related to the extent of bowel involved with eosinophilic infiltration whether mucosa; muscle; and / or subserosa. Peripheral eosinophilia may or may not be present. Diagnosis requires a high index of suspicion and exclusion of other causes of peripheral eosinophilia. We report a case of a young woman who presented with recurrent abdominal pain and ascites. Diagnosis of EGE was made based on clinical, laboratory, radiological and histological criteria. The patient demonstrated overlap between different subtypes of EGE and had an excellent response to steroid treatment.
Spectrum of Surgical Presentation of Eosinophilic Enteritis
Case Reports in Surgery, 2015
Eosinophilic enteritis is a rare disorder presenting mostly with diarrhea, malabsorption, abdominal pain, weight loss, and hypersensitivity. Surgical manifestation of eosinophilic gastrointestinal disorders depends on the site and extent of involvement. In our case series of four patients two of them had ileocaecal masses with recurrent subacute intestinal obstruction with past history of intake of antitubercular drugs for 9 months. On histopathological examination both of them proved to have eosinophilic enterocolitis. Thus it is a clinical dilemma to differentiate between these two conditions. The other two patients presented as acute abdomen with perforation and intussusception. All four patients were treated surgically. Postoperatively they recovered well with no symptoms on one year follow-up. In Indian setup tuberculosis being rampant there may be under reporting or wrongly diagnosed cases of eosinophilic enteritis. Thus a strong clinical suspicion and awareness of this clinical entity are essential among surgical community.
Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic infiltration of one or more segments of gastrointestinal tract. Stricture formation is one of the uncommon occurrences seen in the muscular and serosal type of the disease. Stricturing disease of oesophagus, pylorus and proximal small bowel has been reported earlier. We report a rare case of 48 year old male presenting with intestinal bstruction due to stricture formation in the terminal ileum. CECT of abdomen showed a segmental stricture of terminal ileum. Intraoperatively multiple dense adhesions were seen around ileocaecal junction along with a strictured segment in the terminal ileum. Initially the diseased ileal segment was resected followed by an end ileostomy with a distal mucous fistula. The histopathological examination of the resected sample revealed ulcerated and edematous ileal mucosa with dense inflammatory cells rich in eosinophils infiltrating lamina proparia, muscularis proparia and serosal layer. After a month of the first surgery, a right hemicolectomy with end to end ileotransverse anastomoses was done as a definitive procedure. Patient was put on oral glucocorticoid regimen. He has been asymptomatic during the follow up period of 6 months.
Eosinophilic gastroenteritis presenting with duodenal obstruction and ascites
Annals of the Academy of Medicine, Singapore, 2011
Eosinophilic gastrointestinal disorders or eosinophilic digestive disorders encompass a spectrum of rare gastrointestinal disorders that includes eosinophilic esophagitis, eosinophilic gastroenteritis, and eosinophilic colitis. Eosinophilic gastroenteritis is a rare inflammatory disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations include anemia, dyspepsia, and diarrhea. Endoscopy with biopsy showing histologic evidence of eosinophilic infiltration is considered definitive for diagnosis. Corticosteroid therapy, food allergen testing, elimination diets, and elemental diets are considered effective treatments for eosinophilic gastroenteritis. The treatment and prognosis of eosinophilic gastroenteritis is determined by the severity of the clinical manifestations. We describe a 24-year-old woman with eosinophilic gastroenteritis presenting as epigastric pain with a history of severe iron deficiency anemia, asthma, eczema, and allergic rhinitis, and we review the literature regarding presentation, diagnostic testing, pathophysiology, predisposing factors, and treatment recommendations. (
Spectrum of Surgical Presentation of Eosinophilic Enteritis: A Case Series
Eosinophilic enteritis is a rare disorder presenting mostly with diarrhea, malabsorption, abdominal pain, weight loss and hypersensitivity. Surgical manifestation of eosinophilic gastrointestinal disorders depends on the site and extent of involvement. In our case series of four patients two of them had ileocaecal masses with recurrent subacute intestinal obstruction with past history of intake of anti-tubercular drugs for 9 months. On histopathological examination both of them proved to have eosinophilic enterocolitis. Thus it is a clinical dilemma to differentiate between these two conditions. The other two patients presented as acute abdomen with perforation and intusseption. All four patients were treated surgically. Post operatively they recovered well with no symptoms on one year follow up. In Indian set up tuberculosis being rampant there may be under reporting or wrongly diagnosed cases of eosinophilic enteritis. Thus a strong clinical suspicion and awareness of this clinical entity is essential among surgical community. Keywords: Eosinophilic Colitis (EC); Eosinophilic Enteritis (EE); Obstruction; Perforation; Anti-Tubercular Drugs (AKT).
Intestinal obstruction by eosinophilic jejunitis
Revista Española de Enfermedades Digestivas, 2004
Eosinophilic enteritis is an uncommon disease that rarely develops as a surgical emergency. Although it may be associated with infestation by Ancylostoma caninum, its etiology is unknown and often related to a personal or family history of atopy. A transmural involvement may cause intestinal obstruction-more frequently in the jejunum-or even acute abdomen, which may or may not be accompanied by intestinal perforation. The latter two conditions tend to be more commonly associated with ileum disease, causing pain in the lower right quadrant of the abdomen. Patient history, eosinophil count-which may be paradoxically reduced when the disease appears in this way-, ultrasonography, and/or CT lead to the suspicion of this condition before a surgical procedure is considered. A definitive diagnosis, however, must be reached by means of an anatomopathological study. Macroscopically, intestinal loops exhibit a thickened appearance with an elastic consistency. Laparoscopic intestinal biopsy may play a major role in the diagnosis of disease.
Internal medicine (Tokyo, Japan), 2018
A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.