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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 67, Num. 4, 2005, pp. 227-228

Indian Journal of Surgery, Vol. 67, No. 4, July-August, 2005, pp. 227-228

Letter To Editor

Eosinophilic ascites

Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Lane, Elamakkara P. O. Cochin - 682 026, Kerala
Correspondence Address:Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Lane, Elamakkara P.O., rmgastro@indiatimes.com

Code Number: is05074

Dear Editor,

Eosinophilic gastroenteritis is an inflammatory disease of unknown etiology characterized by infiltration the gastrointestinal tract with eosinophils, accompanied by varying abdominal symptoms and usually by peripheral blood eosinophilia.[1]

A 41-year-old man presented with abdominal distension and postprandial abdominal fullness for 3 weeks. There was no history of fever, abdominal pain or vomiting. He had no history of worm infestation. There was no history of swelling of feet or jaundice. He had no significant medical or family history and was a non-smoker and alcoholic. Physical examination showed presence of ascites. There was no stigma of chronic liver disease.

Investigations showed peripheral eosinophilia with absolute eosinophilic count was 2100/mm3 with elevated ESR of 54. Routine biochemical investigations were normal. Stool examination was normal. Ultrasound abdomen showed moderate ascites. Ascitic fluid analysis showed low serum ascites albumin gradient (SAAG = 0.7), high protein fluid with elevated eosinophil count of 8350 /mm3. CT scan abdomen showed moderate ascites with thickening of jejunum. Push enteroscope passed 150 cm in jejunum, which showed edematous mucosal folds of jejunum. Biopsy from jejunal mucosa showed mucosal and submucosal infiltration of eosinophils. Plain radiograph chest and pulmonary function tests were normal. Bone marrow examinations did not show eosinophilic infiltration. Autoimmune markers like ANA and p-ANCA were negative. Thus, diagnosis of eosinophilic ascites due to serosal eosinophilic gastroenteritis was considered. He was put on oral prednisone, 40 mg/day for 2 weeks followed by slow tapering for 4 weeks. The patient responded to corticosteroids treatment. Patient is asymptomatic on low dose maintenance prednisone 10mg /day for follow up of 13 months.

Eosinophilic ascites is a unique presentation of serosal eosinophilic gastroenteritis. Entire bowel wall is usually involved in serosal eosinophilic gastroenteritis.[1],[2] Mechanism of ascites in serosal eosinophilic enteritis is similar to ascites in peritoneal carcinomatosis. [3] In our patients there was no evidence of hypereosinophilic syndrome or connective tissue disorders. Patient responded to corticosteroid treatment, which is the mainstay of therapy.[3], [4] Since our patient is in remission on low dose prednisone, other steroid sparing agents were not considered in him.

References

1.Talley NJ, Shorter RG, Philips SF, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopahtological study of patients with diseases of mucosa, muscle layer, subserosal tissues. Gut 1990;31:54-8.  Back to cited text no. 1    
2.Malaguarnera M, Restuccia N, Pistone G. Eosinophilic gastroenteritis. Eur J Gastroenterol Hepatol 1997;9:533-7.   Back to cited text no. 2    
3.Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr 2000;30:28-35.  Back to cited text no. 3    
4.Lee CM, Changchien CS, Chen PC. Eosinophilic gastroenteritis: 10 years experience. Am J Gastroenterol 1993;88:70-4.  Back to cited text no. 4    

Copyright 2005 - Indian Journal of Surgery

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