http://courses.md.huji.ac.il/96854/pdf/neonatal intes obst review.pdf

Intestinal obstruction in neonatal/pediatric surgery.

Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

Unusual presentations of eosinophilic gastroenteritis: case series and review of literature.

Eosinophilic enteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract depending upon the predominant layer involved. Diagnosis of eosinophilic enteritis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia. We report a case of unusual presentation of eosinophilic enteritis clinically presenting as intestinal obstruction due to multiple strictures of the small bowel in an adult male.

https://www.mdpi.com/2039-7283/2/1/e24/pdf

Unusual presentation of eosinophilic enteritis as multiple strictures of small intestine.

Eosinophilic enteritis is an uncommon disease that rarely devel-ops 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.

/pdf/intestinal-obstruction-by-eosinophilic-jejunitis-2vmecjv5lq.pdf

Intestinal obstruction by eosinophilic jejunitis.

SUMMARY Idiopathic eosinophilic gastroenteritis is a rare inflammatory disease of unknown origin, characterized by diffuse eosinophilic infiltration of the gastrointestinal tract, accompanied by varying abdominal symptoms related to the location, severity and depth of invasion. Any part of the gastrointestinal tract including the esophagus may be involved, although the stomach and small bowel are the most frequently affected areas. Other sites of involvement include the pancreas, liver and biliary tree and tissues outside gastrointestinal tract. Although the exact etiology is unknown, an allergic disorder is present in almost ‰ of the patients. Increased production of Interleukin-5 and activated eosinophils has been shown to be the rule in all cases. A large proportion of patients demonstrates peripheral eosinophilia. Eosinophil localization to the lamina propria at baseline is critically regulated by eotaxin, a chemokine expressed throughout the gastrointestinal tract. Diagnosis may sometimes be difficult but it can be achieved with the help of endoscopy plus mucosal biopsies, while peripheral and tissue eosinophilia supported by the findings of radiology, ultrasound and computed tomography can establish the diagnosis in the majority of cases. Eosinophilic gastrenteritis should be considered in the differential diagnosis of patients with unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia. Treatment with corticosteroids and the newer ones such as budezonide produces rapid relief of symptoms and clinical signs of the disease. Other valuable therapeutic modalities include administration of immunosuppressives, chromoglycate and dietary restrictions. Surgery is advocated only for obstructing forms of the disease. The course of the disease is characterized by frequent exacerbations and remissions. The long-term prognosis is relatively benign. Patients suffering from eosinophilic gastroenteritis require regular surveillance and prompt treatment in order to avoid possible complications.

Eosinophilic gastroenteritis: Current aspects on etiology, pathogenesis, diagnosis and treatment

Eosinophilic enteritis or gastroenteritis is a rare disease characterised by tissue eosinophilia which can affect different layers of bowel wall. It can affect any area of gastrointestinal tract from the esophagus to the rectum, although stomach and small intestine are sites most frequently reported. It is important to recognize this disease early and institute the necessary treatment. An eight year old girl presented with acute intestinal obstruction. Exploration revealed a structure of proximal jejunum. Histopathology demonstrated eosinophilic jejunitis. The case is reported owing to this rarity and relevant literature is reviewed.

TT Karande

Papers

Proximal jejunal obstruction due to eosinophilic gastroenteritis.