Endoscopy 2011; 43: E358-E359
DOI: 10.1055/s-0030-1256526
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Eosinophilic enteritis presenting as a perforated duodenal ulcer

H.  Issa1 , B.  Bseiso1 , A.  H.  Al-Salem2
  • 1Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
  • 2Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia
Further Information

Publication History

Publication Date:
08 November 2011 (online)

Eosinophilic gastroenteritis (EGE) is a rare condition of unknown etiology that is characterized by eosinophilic infiltration in the layers of the gastrointestinal tract [1]. It can affect any part of the gastrointestinal tract but most commonly affects the stomach [1] [2]. This report describes a rare case of EGE presenting as a perforated duodenal ulcer with subsequent duodenal stenosis.

A 26-year-old man was referred to us with duodenal obstruction following a laparotomy for a perforated duodenal ulcer. He had undergone repair of the ulcer and 2 weeks later had presented with vomiting and weight loss. Endoscopy showed gastritis and a duodenal ulcer with stenosis ([Fig. 1]). A barium meal showed narrowing at the first part of the duodenum ([Fig. 2]). He was given treatment for Helicobacter pylori and pantoprazole. A repeat endoscopy 2 months later showed a deformed pylorus, prepyloric nodular mucosa, and an almost circumferential duodenal ulcer with significant narrowing.

Biopsies from the ulcer showed a marked eosinophilic infiltrate diagnostic of EGE ([Fig. 3]). He received prednisolone as a tapered course over 1 month and pantoprazole, after which, there was a marked improvement in his symptoms. A repeat endoscopy showed a healed duodenal ulcer and a postbulbar stricture ([Fig. 4]). Central radial expansion balloon dilation was performed. He received another course of steroids and 1 month later was well and gaining weight with no vomiting.

Fig. 1 Esophagogastroduodenoscopy showing gastritis and a duodenal ulcer with stenosis.

Fig. 2 Barium meal showing a short segment of narrowing in the first part of the duodenum with peripheral ulceration suggesting chronic ulceration with secondary fibrotic changes and subsequent narrowing.

Fig. 3 Biopsies from the duodenal ulcer showing a marked eosinophilic infiltrate, diagnostic of eosinophilic gastroenteritis (EGE).

Fig. 4 Esophagogastroduodenoscopy showing a healed duodenal ulcer and a postbulbar stenosis that was subsequently dilated.

Talley et al. suggested three diagnostic criteria for EGE: (i) gastrointestinal symptoms; (ii) demonstration of eosinophilic infiltration in the gastrointestinal tract, or presence of high eosinophil count in fluid; (iii) no evidence of parasitic or extraintestinal disease [3]. EGE has been classified, depending on the extent of bowel wall involvement, into mucosal, muscular, and serosal [1] [3]. In the past, peptic ulceration accounted for most cases of gastric outlet obstruction. Nowadays, other causes such as malignancy and EGE must be excluded.

EGE may also present acutely [4] [5] as was the case for our patient who presented with peritonitis secondary to a perforated peptic ulcer, with a subsequent stricture that was presumed to be postsurgical but proved to be due to EGE. To the best of our knowledge, this is the first report of EGE presenting as a perforated duodenal ulcer.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AC

References

  • 1 Khan S, Orenstein S R. Eosinophilic gastroenteritis.  Gastroenterol Clin N Am. 2008;  37 333-348
  • 2 Chen M J, Chu C H, Lin S C. et al . Eosinophilic gastroenteritis: clinical experience with 15 patients.  World J Gastroenterol. 2003;  9 2813-2816
  • 3 Talley N J, Shorter R G, Phillips S F, Zinsmeister A R. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues.  Gut. 1990;  31 54-58
  • 4 Blanco-Guerra C, Cazana J L, Villas F. Ileal perforation due to eosinophilic gastroenteritis.  Am J Gastroenterol. 1991;  86 1689-1690
  • 5 Maeshima A, Murakami H, Sadakata H et al. Eosinophilic gastroenteritis presenting with acute pancreatitis.  J Med. 1997;  28 265-272

A. H. Al-SalemMD 

Department of Pediatric Surgery, Maternity and Children Hospital, Dammam

P.O. Box 61015
Qatif 31911
Saudi Arabia

Email: ahsalsalem@hotmail.com

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