Eosinophilic Gastroenteritis Presenting with Duodenal Obstruction and Ascites Letter to the Editor

Eosinophilic Gastroenteritis-Kian, Chai Lim
2011 unpublished
Dear Editor, Eosinophilic gastroenteritis (EG) is a rare infl ammatory disorder of the gastrointestinal tract of unknown aetiology. It is characterised by eosinophilic infi ltration of the bowel wall, peripheral eosinophilia and various gastrointestinal manifestations. We report CT appearances in a rare case of EG with duodenal obstruction, peripheral eosinophilia and eosinophilic ascites, which responded promptly to steroid therapy. Case Report A 31-year-old man was admitted with 3 weeks
more » ... y of progressive epigastric discomfort, vomiting and diarrhoea, which was aggravated by meals. He had no history of fever, weight loss, abdominal surgery or any known food allergy. He denied taking any drugs or herbal medicines. On clinical examination, he appeared dehydrated and vitals were normal. His abdomen was soft and slightly distended. Laboratory investigations showed a high white cell count of 24.1 x 10 9 /L, with raised eosinophils count of 12.51 x 10 9 /L. The haemoglobin level and platelet counts were normal. The liver function tests, erythrocyte sedimentation rate, C-reactive protein and autoimmune antibody screen were normal. The serum immunoglobulin-E (IgE) was mildly raised at 103 IU/ml (normal reference range, 0 to 87 IU/ ml). Stool culture for pathogens and analyses for ova, cysts and parasites were negative. Serum anti-amoebic antibody and serology for strongyloides were negative. Endoscopy revealed large mucosal folds in the gastric antrum and proximal duodenum causing obstruction (Fig. 1) and the endoscope was not able to pass through. Endoscopic ultrasound (EUS) showed thickened gastric antral wall involving all layers. Multiple biopsies were obtained from the gastric antrum and duodenum. During the admission, the abdominal pain and vomiting worsened. An abdominal radiograph showed dilated small bowel. Computerised tomography (CT) revealed dilated and oedematous duodenum and proximal jejunal loops (Fig. 2). The distal ileal loops were also dilated and no defi nite transition point of obstruction was seen. The colon was normal. So were the liver, spleen and pancreas. There was moderate amount of ascites with no evidence of infl ammation. There was no lymphadenopathy. The mucosal biopsies showed gastritis, duodenitis, Fig. 1. Endoscopic view of the junction of the fi rst and second parts of duodenum showing large mucosal folds. Fig. 2. Axial image of CT abdomen, with intravenous and oral contrast medium administration, showing dilated and oedematous duodenum and proximal jejunum (arrows). Incidental note of gut malrotation with the jejunal loop (j) located to the right of duodenum (d) is demonstrated. There is moderate amount of ascites (*).
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