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Indian Journal of Surgery, Vol. 65, No. 6, November-December, 2003, pp. 512-513 Eosinophilic gastroenteritis presenting as pyloric obstruction Sujata Nayak, Vaishali S. Vaidya, Sanjay D. Deshmukh Department of Pathology, B. J. Medical College & Sassoon General Hospitals, Pune - 411001, India. Paper Received: June 2002. Paper Accepted: August 2002. Source of Support: Nil. How to cite this article: Nayak S, Vaidya VS, Deshmukh SD. Eosinophilic gastroenteritis presenting as pyloric obstruction. Indian J Surg 2003;65:512-3. Code Number: is03111 ABSTRACT Eosinophilic gastroenteritis presenting as pyloric obstruction is rare. It may mimic gastric malignancy in the elderly or idiopathic hypertrophic pyloric stenosis in infants. A case report of an elderly male with this entity is described. Key words: Eosinophilic, Gastroenteritis INTRODUCTION Eosinophilic gastroenteritis (EG) is a rare disease affecting the gastrointestinal tract. As a result, the diagnosis may be missed or the symptoms misinterpreted. We report here a case of EG in a 60-year-old male presenting with pyloric obstruction which was clinically thought to be due to malignancy. CASE REPORT A 60-year-old male presented with pain in abdomen of 2 months duration which had progressively increased since 4 days. Abdominal examination revealed mild tenderness and absence of bowel sounds. Ultrasonography indicated an obstructive lesion arising from the antrum. Preoperative laboratory investigations including complete blood count were within normal limits. At laparotomy the pylorus was found thickened and a small (1 x 0.5 cm) prepyloric ulcer was noted. A Billroth type II gastrectomy was performed. The specimen of the stomach received showed a thickened oedematous wall and a firm thickened ring at the pylorus. Histological sections revealed diffuse infiltrate mainly in the muscle and serosal layers consisting predominantly of eosinophils and fewer polymorphs (Figure 1). No parasites or malignancy was detected. The diagnosis given on histology was eosinophilic gastroenteritis. DISCUSSION EG is an uncommon disease characterized by gastrointestinal symptoms, eosinophilic infiltration of one or more layers of the gastrointestinal tract, and peripheral eosinophilia.1-3 Its aetiology is unknown, although allergy to food, drugs or toxins has been postulated.1,3 Though the disease may involve any part of the gastrointestinal tract, it usually affects the stomach and small intestine.3 Klein4 reported three pathological manifestations of EG: mucosal involvement, which results in malabsorption; muscle layer disease which results in obstruction, and serosal involvement which presents with ascites. EG presenting as pyloric obstruction as seen in the present case is extremely rare.1,2 Definitive diagnosis requires histological evidence of eosinophilic infiltration in the absence of parasitic infestation, and Crohn's disease, and of eosinophilic infiltration of extraintestinal organs.3,4 The presence of peripheral eosinophilia is not a pre-requisite for diagnosis.5 Its absence as in the present case has been reported.5 When a patient presents with signs of intestinal obstruction as seen in this case, surgical exploration becomes necessary to relieve obstruction and to disprove the possibility of malignancy. In infants EG closely mimics idiopathic hypertrophic pyloric stenosis.6 The clinical course is unpredictable and the response to corticosteroids and sodium cromoglycate variable.1 REFERENCES 1. McCune WS, Gusack M, Newman W. Eosinophilic gastroduodenitis with pyloric obstruction. Ann Surg 1955;142:510-6. 2. Chaudhary R, Shrivastava RK, Mukhopadhyay HG, Diwan RN, Das AK. Eosinophilic gastritis _ an unusual cause of gastric outlet obstruction. Ind J Gastroenterol 2001;20:110. 3. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney system. Am J Surg Pathol 1996;20:1161-81. 4. Klein NC, Hargrove RL, Sleisenger MH. Eosinophilic gastgroenteritis. Medicine 1970;49:229-319. 5. Kamal MF, Shaker K, Jaser N, Leimoon BA. Eosinophilic gastroenteritis with no peripheral eosinophilia. Ann Chir Gynaecol 1985;74:98-100. 6. Hummer-Ehret BH, Rohrschneider WK, Oleszczuk- Raschke K, Nutzenadel W, Troger J. Eosinophilic gastroenteritis mimicking idiopathic hypertrophic pyloric stenosis. Pediatr Radiol 1998;28:711-3. © 2003 Indian Journal of Surgery. Also available online at http://www.indianjsurg.com The following images related to this document are available:Photo images[is03111f1.jpg] |
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