Case Report: Eosinophilic Gastroenteritis Presenting as Intestinal Obstruction - A Case Series. Amita Krishnappa, Assistant Professor, Department of Pathology, Shameem A Shariff, Professor, Department of Pathology, Ashok D Kumar, Department of Surgery, MVJ Medical College & Research Hospital, Bangalore, India. Address for Correspondence: Dr. Amita K, C/O C Gangadharan,#542, 1 st Main, 6 th cross, Annasandrapalya, Vinayaka nagar, HAL, Bangalore, India. E-mail: dramitay@rediffmail.com Citation: Amitha K, Shariff SA, Kumar AD. Eosinophilic Gastroenteritis Presenting as Intestinal Obstruction - A Case Series. Online J Health Allied Scs. 2011;10(2):21 URL: http://www.ojhas.org/issue38/2011-2-21.htm Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html Submitted: Apr 19, 2011; Accepted: Jul 15, 2011; Published: Jul 30, 2011 Abstract: Eosinophilic Gastroenteritis is a rare disease charac- terized by infiltration of the gastrointestinal tract by an in- creased number of eosinophils as compared to the normal. The anatomic location and intensity of the infiltrate decides the var- ied clinical symptomatology with which these patients present. The present report deals with four cases, all presenting with clinical signs of intestinal obstruction A laparotomy performed revealed a stricture in the first case, superficial ulcers and adhe- sions in the second case, an ileocaecal mass in the third case and volvulus formation in the fourth case. Eosinophilic gast- roenteritis was confirmed on histopathology in all the four cases. All the four patients experienced relief of symptoms after resection. It is essential to diagnose the disease to differentiate it from other conditions presenting as intestinal obstruction. The cases are presented because of the rarity of occurrence and presentation. Relevant literature has been reviewed. Key Words: Gastroenteritis; Eosinophils; Intestinal obstruc- tion; Ascites Case Report: The details on all the four cases are outlined in the tables 1 and 2. Table1 shows the clinical manifestations and ultrasound find- ings (US) and table 2 depicts the other laboratory, gross and histopathologic findings. Table 1: Clinical manifestations, ultrasound findings and clinic- al diagnosis. No. Age / Sex Symptoms US Clinical dia- gnosis 1 55/F Pain and distension of abdo- men- three months. Constipation - three days. Similar complaints six months back – managed conservatively Fluid filled loops; as- cites; mesentric lymph nodes-en- larged Intestinal tuberculosis. Started on anti tubercu- lous therapy. 2 23/M Abdominal pain on and off -15 days. Vomiting - two days. Ascites Intestinal ob- struction ? cause 3 39/F Pain in the right lower quad- rant of the abdomen with vomiting-one week. Mass in right iliac fossa. Minimal as- cites Intestinal ob- struction ? due to neo- plasm 4 20/F Pain abdomen and vomiting - one day Ascites Sub acute in- testinal ob- struction ? cause Table 2: Laboratory, gross and histopathological findings in all the four cases. No . Lab findings Gross findings Microscopy and histopathologic diagnosis 1 AEC a -200 cells /cu mm. Chest X ray- NAD b Stool examina- tion-NAD. Montoux test- negative ESR-normal 20cm of small bowel with a stricture located three cm from one resected margin. Mucosa over the stricture – ulcerated Three lymph nodes identi- fied. Mucosal ulceration and transmural in- filtration by eos- inophils. Impression: Eos- inophilic enteritis with stricture 2 AEC-310 cells /cu mm. Chest X ray- NAD Stool examina- tion-NAD. A segment of small intestine 60 cm in length with caecum and ascending colon measur- ing six cm in length. Small intestine showed adhesion of loops with mucosal hemor- rhage and multiple ulcers varying from 0.3 to 0.6 cm over a length of 15 cm. Two mesenteric lymph nodes identified each meas- uring 0.5 cm across. Mucosal ulcera- tion, hemorrhage and transmural in- filtration by eos- inophils Impres- sion: Eosinophilic enteritis with in- testinal adhesions 3 AEC-150 cells /cu mm. Chest X ray- NAD Stool examina- tion-NAD. Ileum, caecum, appendix and a part of ascending colon measuring 26 cm in length. Small intestine was coiled up to form mass six cm in diameter. Cut surface of mass like lesion -necrotic and hemorrhagic. Areas of gangrene noted. Transmural infilt- ration by eosino- phils over a local- ized area with reac- tion and fibrosis. Impression: Eos- inophilic enteritis with pseudotumor formation 4 AEC-600 cells /cu mm Chest X ray- NAD Stool examina- tion-NAD. Ileum, appendix and caecum. Ileum-35 cm Adhesions noted with looped up small intestine. Cut surface -NAD Mucosal ulcera- tion, submucosal congestion and transmural infiltra- tion by eosinophils Impression: Eos- inophilic enteritis with volvulus a- Absolute eosinophil count (AEC) Normal range-40-440 cells/cu mm b- NAD-No abnormality detected 1 This work is licensed under a Creative Commons Attribution- No Derivative Works 2.5 India License Online Journal of Health and Allied Sciences Peer Reviewed, Open Access, Free Online Journal Published Quarterly : Mangalore, South India : ISSN 0972-5997 Volume 10, Issue 2; April-June 2011