CASE 4981 Published on 03.07.2006

Eosinophilic enteritis presenting as acute abdominal pain

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Tziafalia C. ,Fezoulidis I.V., Radiology Department , University Hospital Larissa, Greece, Feidiou 1, Karditsa, 43 100 , Greece

Patient

35 years, male

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Clinical History

A 35-year-old man was suffering from epigastric pain, vomiting and mild fever for a period of a week.

Imaging Findings

A 35-year-old man was admitted to our hospital complaining of epigastric pain immediately after feeding, as well as vomiting and fever. His abdomen was distended in the epigastric region. Abdominal radiograph was negative for pathology, but ultrasonography and computed tomography revealed dilatation of stomach and duodenum, as well as thickening of their walls. Laboratory examinations revealed leukocytosis with eosinophilia. The patient underwent gastroscopy. Histologically, dense infiltration of eosinophils was found transmurally, and eosinophilic enteritis was diagnosed.

Discussion

Eosinophilic enteritis is a rare condition of unknown aetiology, that rarely develops as a surgical emergency. Its etiology is unknown and often related to a personal or family history of atopy although it is generally believed to be due to intestinal allergy. It may also be associated with infestation by Ancylostoma caninum. It may mimic peptic ulcer, intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. Patient history, eosinophil count, ultrasonography, and CT lead to the suspicion of this condition. A definitive diagnosis, however, must be reached by means of an anatomopathological study.

Differential Diagnosis List

Eosinophilic duodenitis.

Final Diagnosis

Eosinophilic duodenitis.

References

[1] Eosinophilic enteritis--a diagnostic dilemma.

Clegg-Lamptey JN, Tettey Y, Wiredu EK, Kwawukume EY.

Department of Surgery, University of Ghana Medical School, P.O. Box 4236, Accra. (PMID: 12744585)

[2] Eosinophilic gastrointestinal disorders (EGID).

Rothenberg ME.

Department of Pediatrics, Cincinnati Children\'s Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. (PMID: 14713902)

[3] Intestinal obstruction by eosinophilic jejunitis

Alamo Martinez JM, Ibanez Delgado F, Galindo Galindo A, Bernnal Bellido C, Duren Ferreras I, Suarez Artacho G, Martinez Vieira A.

Department of Surgery, University Hospital Virgen del Rocio, Seville, Spain. (PMID: 15259143)

[4] Eosinophilic enteritis presenting as acute intestinal obstruction: a case report and review of the literature.

Uenishi T, Sakata C, Tanaka S, Yamamoto T, Shuto T, Hirohashi K, Kubo S, Kinoshita H.

Second Department of Surgery, Osaka City University Medical School, Osaka, Japan. m6877710@msic.med.osaka-cu.ac.jp. (PMID: 12806199)

[5] Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review.

Charalabopoulos A, Charalabopoulos K, Avuzuklidou M, Charalabopoulos AK, Ioachim E, Lebren F, Fotiadis K.

Third Department of Surgery, Athens University Medical School, Sotiria General Hospital, Athens, Greece. (PMID: 15161129)

Case information