Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico / Eosinophilic enteritis, a strange cause of acute abdomen Clinical case report

La enteritis eosinofílica, es una patología rara, caracterizada por infiltración de eosinófilos en una o más capas histológicas en diferentes niveles del tracto gastrointestinal, siendo el estómago e intestino delgado los más afectados; su cuadro clínico, inespecífico, caracterizado por dolor abdominal, náusea, vómito, diarrea o estreñimiento, pérdida de peso y ascitis, con presencia o ausencia de eosinofilia en la biometría. Reporte de caso Paciente masculino de 51 años de edad, acudió a emergencia por distensión abdominal y náusea, al examen físico en la palpación intenso dolor y distención abdominal, percusión timpánico y abolición de ruidos hidroaéreos. La analítica reportó leucocitosis con neutrofilia, radiografía de abdomen íleo adinámico, en la ecografía abdominal presencia de imágenes tubulares con aspecto de diana, asociado a líquido libre purulento en fosa ilíaca derecha y fondo de saco vésico rectal. Un cuadro clínico compatible con abdomen agudo de resolución quirúrgica, se realizó laparotomía exploratoria (AU);

The eosinophilic enteritis is a rare pathology, characterized by infiltration of eosinophils in one or more histological layers at different levels of the gastrointestinal tract, the stomach and small intestine being the most affected; its nonspecific clinical picture, characterized by abdominal pain, nausea, vomiting, diarrhea or constipation, weight loss and ascites, with the presence or absence of eosinophilia in the biometry. Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico Eosinophilic enteritis, a strange cause of acute abdomen year-old male patient came to the emergency room due to abdominal distention and nausea, to physical examination on palpation, intense abdominal pain and distention, tympanic percussion and abolition of air-fluid sounds. Laboratory analysis reported leukocytosis with neutrophilia, abdominal ileus adynamic radiography, abdominal ultrasound presence of tubular images with a target appearance, associated with free purulent fluid in the right iliac fossa and rectal vesicum fundus. A clinical picture compatible with an acute abdomen with surgical resolution, an exploratory laparotomy was performed (AU);

Gastric outlet obstruction as manifestation of eosinophilic gastroenteritis / Obstrucción gástrica como manifestación de gastroenteritis eosinofílica

RESUMEN La gastroenteritis eosinofílica (EG) es una entidad poco frecuente. Presentamos un varón de 55 años sin antecedentes de atopía ni alergia, que presentó dolor abdominal y vómitos. La tomografía computarizada abdominal y la ecoendoscopia demostraron engrosamiento de la pared gástrica con engrosamiento de la pared del duodeno superior, sin masa definida ni colección de líquido. La endoscopia gastrointestinal confirmó engrosamiento de pliegues prepilóricos y duodeno superior con estenosis luminal. Se realizó gastrectomía parcial por ausencia de diagnóstico definitivo y sospecha de posible malignidad y diagnóstico de obstrucción de la salida gástrica. La histopatología fue compatible con EG, tratada con un tratamiento con corticoides de 8 semanas de duración, mostró mejoría clínica, aumento de peso y normalización del recuento de eosinófilos en sangre periférica.

ABSTRACT Eosinophilic gastroenteritis (EG) is a rare entity. We report a 55-year-old man had no previous atopy or allergic history, who presented abdominal pain and vomiting. Abdominal computed tomography and endoscopy ultrasonography demostrated gastric wall thickening with wall thickening of the superior duodenum, without defined mass or fluid collection. Gastrointestinal endoscopy confirmed thickening of prepyloric folds and superior duodenum with luminal stenosis. Parcial gastrectomy was performed due to absence of definitive diagnosis and suspicion of possible malignancy and diagnosis of gastric outlet obstruction. Histopathology was compatible with EG, treated with an 8-week long corticosteroid therapy, showed clinical improvement, weight gain and normalization of eosinophil count on peripheral blood.

Intestinal intussusception secondary to enteritis caused by Pythium insidiosum in a bitch: case report / Intussuscepção intestinal secundária à enterite causada por Pythium insidiosum em uma cadela: relato de caso

We report a case of intestinal intussusception secondary to enteritis caused by Pythium insidiosum infection in a 1-year-old mixed breed bitch that died after a 30-day history of bloody diarrhea, anorexia, weight loss, listlessness, dehydration, and pale mucous membranes. Necropsy revealed two areas of intussusception, one jejunum-jejunal and one ileum-cecum-colic. The first intussusception showed slight congestion of the intestinal loop, which was resolved by manual traction, while the second intussusception exhibited thickening, irregular yellow spots, and transmural congestion. Histologically, the jejunum-jejunal segment had ischemic lesions secondary and ileum-cecum-colic intussusception there was also necrotizing, pyogranulomatous enteritis associated with negative images of intralesional fungal hyphae that were well visualized by silver impregnation. Immunohistochemistry identified the hyphae as Pythium insidiosum. The diagnosis was made based on the histological changes and confirmed by immunohistochemistry. We can conclude that enteritis by P. insidiosum in dogs can occasionally cause intestinal intussusception and result in acute death.(AU)

Relata-se um caso de intussuscepção intestinal secundária à enterite causada por Pythium insidiosusm em uma cadela, sem raça definida, com um ano de idade, que morreu após apresentar 30 dias de diarreia sanguinolenta, anorexia, perda de peso, apatia, desidratação e mucosas pálidas. Na necropsia verificaram-se duas áreas de intussuscepções, sendo uma jejuno-jejunal e outra íleo-ceco-cólica. Na primeira havia discreta congestão, que foi desfeita pela tração manual, e na segunda observou-se espessamento segmentar, focos amarelados irregulares e congestão transmural do intestino. Microscopicamente, no segmento jejuno-jejunal observaram-se moderadas lesões isquêmicas secundárias à intussuscepção, e no segmento íleo-ceco-cólica verificou-se enterite piogranulomatosa e necrosante, segmentar, associada a imagens negativas de hifas intralesionais, impregnadas pela prata. Pela imuno-histoquímica, as hifas foram imunomarcadas para Pythium insidiosum. O diagnóstico foi realizado com base nas características microscópicas das lesões e morfotintoriais das hifas e foi confirmado pela imuno-histoquímica. De acordo com esses dados, é possível concluir que a infecção intestinal por P. insidiosum em cães pode causar intussuscepção e morte.(AU)

Eosinophilic Gastroenteritis Presenting as Small Bowel Obstruction.

Eosinophilic gastroenteritis is a rare disease of unknown etiology characterized by eosinophilic infiltration of bowel wall to a variable depth. A 38 year old female presented with loose stool and vomiting since 3 days. She gave history of pain abdomen and weight loss since six months. Barium study revealed ascending colon stricture just proximal to the hepatic flexure ? malignant. A colonic biopsy was done, which was reported as edematous colonic mucosa with mild increase in eosinophils. Intra-operatively, a dense long segment stricture was found in the ascending colon extending to the caecum which warranted a right hemicolectomy. Histopathology revealed dense infiltration of eosinophils in the entire thickness of ileal and caecal wall. The diagnosis of eosinophilic gastroenteritis was made. Patient responded well to steroids. The case is being reported to highlight its rarity due to caecal involvement, presentation as intestinal obstruction and missed diagnosis on endoscopic biopsy.

A Patient with Eosinophilic Gastroenteritis Presenting with Acute Pancreatitis and Ascites

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, especially the stomach and duodenum. EGE has vague, nonspecific symptoms, including nausea, vomiting, abdominal pain, diarrhea, weight loss, ascites, and malabsorption. Here, we report a patient with EGE presenting with concurrent acute pancreatitis and ascites. A 68-year-old woman was admitted with abdominal pain, nausea, vomiting, and watery diarrhea. Laboratory findings revealed elevated serum titers of amylase, lipase, and peripheral blood eosinophil count. An abdominopelvic computed tomography scan showed a normal pancreas, moderate amount of ascites, and duodenal thickening. A esophagogastroduodenoscopy showed patchy erythematous mucosal lesions in the 2nd portion of the duodenum. Biopsies from the duodenum indicated eosinophilic infiltration in the lamina propria. The patient was successfully treated with prednisolone and montelukast. Despite its unusual occurrence, EGE may be considered in the differential diagnosis of unexplained acute pancreatitis, especially in a patient with duodenal edema on imaging or peripheral eosinophilia.

Retención de cápsula endoscópica como complicación de enteritis actínica: reporte de un caso / Retention of capsule endoscopy as a complication of radiation enteritis: a case report

La cápsula endoscópica es un método, que ha modificado el enfoque diagnóstico de numerosos procesos patológicos en el intestino delgado, sin embargo presenta complicaciones como la retención de la misma. Se estima en la literatura mundial que esta suele ocurrir en menos del 2% de los casos. Femenino de 40 años de edad, con antecedente de cáncer de cuello uterino (2011) en tratamiento con quimioterapia, radioterapia convencional y braquiterapia, que presenta cuadro clínico caracterizado por dolor urente en mesogastrio, y emesis de aspecto biliosos. Ruidos hidroaéreos presentes, dolor a la palpación de mesogastrio sin irritación peritoneal. Radiografía de abdomen y ecosonograma abdominal normales. TAC abdomino pélvica con contraste oral con adecuada progresión de contraste hasta el recto. Se practica gastroscopia y colonoscopia sin evidencia de alteraciones. En vista de persistencia de sintomatología se indica realización de cápsula endoscópica observando en íleon distal, a los 246 minutos del paso duodenal, área muy congestiva, con una úlcera circunferencial friable, que no permite el avance de la misma. Se indica tratamiento médico con laxantes por 72 horas, el cual es infructuoso, por lo cual es llevada a mesa operatoria por presentar signos francos de obstrucción intestinal. Los hallazgos fueron: adherencias en flanco y fosa ilíaca derecha, las cuales fueron liberadas, y segmento de íleon a 10 cm de la válvula ileocecal con inflamación franca, practicándose resección y anastomosis termino-lateral. El estudio histopatológico reportó enteritis crónica activa exulcerada, necrosis fibrinoide de pequeños vasos, y fibrosis en la submucosa. Paciente con post-operatorio exitoso decidiéndose el egreso de la institución. Excelente correlación entre los hallazgos de la cápsula endoscópica y la intervención quirúrgica. Los hallazgos de la cirugía se encuentran relacionados al uso de radioterapia convencional, por lo cual recomendamos la realización de pexia...

Capsule endoscopy is a method that has changed the diagnostic approach to many pathological processes in the small intestine, but it has complications such as retention of the same, is estimated in the literature that this usually occurs in less than 2% cases. Women 40 years of age, with a history of cervical cancer (2011) undergoing chemotherapy, conventional radiation therapy, and brachytherapy, presenting clinical picture characterized by burning pain in midgut, and bilious emesis aspect. Present bowel sounds, tenderness of mesogastrium without peritoneal irritation. Abdominal radiography and abdominal ultrasonography normal. Pelvic CT with oral contrast Abdomino with progression adequate contrast to the rectum. Gastroscopy and colonoscopy was performed without evidence of tampering. In view of the persistence of symptoms embodiment shown in watching endoscopic capsule distal ileum, to 246 minutes of step duodenal study, very congestive area with a circumferential friable ulcer which does not allow the advance thereof. Indicated medical treatment with laxatives for 72 hours being fruitless, operating table being carried by presenting overt signs of intestinal obstruction. The findings were: adhesions flank and right lower quadrant, which were released and ileal segment 10 cm from the ileocecal valve with frank inflammation resection and end-side anastomosis. Histopathological study reported chronic active enteritis exulcerada, fibrinoid necrosis of small vessels, and fibrosis in the submucosa. Postoperative patient deciding successful graduation from the institution. Excellent correlation between the findings of capsule endoscopy and surgery. The findings at surgery are related to the use of conventional radiotherapy, so we recommend an pexia of the organs that are in the radiation field, prior to it, and intestinal transit before indicating capsule endoscopy

Acute Extensive Ischemic Enteritis in a Young Man Diagnosed with Wireless Capsule Endoscopy: A Case Report / 대한소화기학회지

Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.

Cytomegalovirus Enteritis Causing Ileal Perforation in an Elderly Immunocompetent Individual

Cytomegalovirus (CMV) infection is usually subclinical in immunocompetent individuals, however it can be life threatening in an elderly immunocompetent individual. We report a case of CMV enteritis causing ileal perforation in a physically active elderly man. An 88-year-old healthy man presented with abdominal pain and diarrhea. After initial conservative treatment, emergency laparotomy was performed for ileal perforation. The diagnosis of CMV enteritis was based on histological findings revealing many large cells with CMV inclusion bodies in the surgical specimen. In elderly individuals, even though they are immunocompetent, CMV enteritis may result in major complications such as bowel perforation, and it should be included in the differential diagnosis of diarrhea if it is resistant to conventional treatment.

Eosinophilic Enteritis Presenting as Intussusception in Adult

Eosinophilic gastroenteritis is defined as a disorder that selectively affects the gastrointestinal tract with eosinophil-rich inflammation in the absence of any known causes for eosinophilia. The clinical manifestations vary according to the site of the eosinophilic infiltrated layer of the bowel wall. Eosinophilic enteritis presenting as intussusception in adult has not been previously reported in the literature. Especially, making the diagnosis of intussusception in adults is often difficult due to the variable clinical findings. In our case, the correct diagnosis of intussusception due to eosinophilic enteritis was arrived at rather easily based on the ultrasonography and endoscopic biopsy. The patient was treated with oral prednisolone at 30 mg/day for 7 days, and then the drug was tapered off for 2 months; we didn't perform surgery. He has been asymptomatic for about 1 year after discharge without disease recurrence.

Massive gastrointestinal bleeding in a patient with AIDS.

Cytomegalovirus enteritis can lead to gastrointestinal bleeding in patients with the acquired immune deficiency syndrome. The commonest site of involvement is the colon, followed by the stomach and terminal ileum. Most of these lesions can be diagnosed by colonoscopy or gastroscopy. We present our experience of a patient with cytomegalovirus infection involving only the proximal jejunum causing massive lower gastrointestinal bleeding. Conventional endoscopy and imaging had failed to locate the source of bleeding. Enteroscopy performed at the time of laparotomy showed an ulcerated lesion in the jejunum. Resection followed by histological examination of the resected area confirmed the diagnosis of cytomegalovirus infection. In addition to highly active antiretroviral therapy, ganciclovir was given for 14 days in a dose of 5 mg/kg twice a day and tapered over a period of 3 months. There has been no further episode of gastrointestinal bleeding over a follow up of 9 months.

Visualization of Jejunal Bleeding by Capsule Endoscopy in a Case of Eosinophilic Enteritis

Eosinophilic enteritis is a rare disease characterized by tissue eosinophilia, which can affect different layers of bowel wall. Normally, the disease presents as colicky abdominal pain, and rarely as an acute intestinal obstruction or perforation. In this paper, we report a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis. Seventeen days after operation, intermittent abdominal pain occurred again, and subsided upon 30 mg per day treatment with prednisolone. Fourteen days after this pain attack, the patient exhibited hematochezia, in spite of continuous prednisolone treatment. Capsule endoscopy showed fresh blood spurting from the mid-to-distal jejunum, in the absence of any mass or ulcer. This hematochezia rapidly disappeared following a high-dose steroid injection, suggesting it was a manifestation of jejunal eosinophilic enteritis.

Laparoscopy in eosinophilic jejunitis presenting as subacute bowel obstruction: a case report.

Eosinophilic gastroenteritis is rare, seen in approximately 1 in 10,000 hospital admissions. The diagnosis is often retrospective and histopathological. Abdominal pain and obstructive symptoms associated with weight loss are the usual presenting complaints. We report a patient with symptoms of proximal bowel obstruction in whom diagnosis could not be made with conventional radiology and endoscopy. Laparoscopy showed that an intensely thickened proximal jejunum to be the cause of the obstruction. A laparotomy and resection anastomosis were done. The biopsy showed eosinophilic jejunitis. The patient did well post-operatively. The literature of this disease entity has been reviewed. Full-thickness laparoscopic biopsy and a course of steroids might avoid a laparotomy in these patients.

Phlegmonous Enteritis in a Patient with Congestive Heart Failure and Colon Cancer

Phlegmonous enteritis is a rare infective inflammatory disease of the intestine, predominantly involving the submucosal layer. It is difficult to diagnose and often fatal. Its association with alcoholism and various liver diseases, although rarely reported, is well documented. We report a case of phlegmonous enteritis in a male patient with congestive heart failure and colon cancer, and describe the ultrasonographic and CT findings.

Eosinophilic enteritis caused chronic partial small intestinal obstruction: a case report and review of the literature.

This is the case-report of a rare cause of chronic small intestinal obstruction by eosinophilic enteritis. A 53-year-old woman presented with an 8-month history of severe intermittent abdominal colick associated with malnutrition, weight loss, and bowel habit change. Several investigations were done but failed to demonstrate the cause. Exploratory laparotomy was therefore performed and the cause of partial small bowel obstruction was found to be eosinophilic enteritis.

Anestesia en trasplante de intestino delgado: informe del primer caso en Argentina / Anesthesia in small bowel transplantation: first case report in Argentine

Antecedentes: El trasplante de intestino delgado es un complejo procedimiento que se practica a adultos o niños que, por distintas causas, sufren una amplia resección de ese órgano. Esta intervención puede ser el tratamiento definitivo para los enfermos con síndrome de malaabsorción, que se encuentran obligados a recibir alimentación parenteral el resto de su vida, con graves efectos colaterales. Objetivos: Describir la conducta anestésica empleada en el primer caso de trasplante de intestino delgado en nuestro país. Lugar de aplicación: Hospital Italiano de Buenos Aires. Diseño: Estudio descriptivo. Población: Niño de 6 años, con síndrome de intestino corto desde los 6 meses por enteritis necrotizante. Recibió alimentación parenteral durante 5 años y medio, por lo que desarrolló insuficiencia hepática de grado leve con alteraciones de la coagulación. Método: Técnica anestésica: premedicación con midazolam 0.1 mg/kg y fentanilo 1.5 µg/kg. Mantenimiento: remifentanilo 1 µg/kg/min y oxígeno/aire en mezcla con isofluorano. Monitoreo : presión arterial invasiva, presión de la arteria pulmonar y de enclavamiento, oximetría y capnografía, ECG, temperatura central, diuresis, estado ácido-base, hematocrito y hemoglobina, ácido láctico, calcio iónico, glucemia, control de la coagulación, monitoreo neuromuscular, consumo y disponibilidad de oxígeno y saturación venosa mixta de oxígeno. Hidratación intraoperatoria: infusión continua de albúmina. Se mantuvo la estabilidad hemodinámica con fenilefrina (0.5 µg/kg/min) y dopamina (5µg/kg/min.). Para la corrección de las alteraciones de la coagulación fue necesario utilizar hemoderivados. El uso de fenilefrina disminuyó la exigencia de excesiva hidratación intraoperatoria. Resultados: Se alcanzaron los objetivos propuestos: prevenir el edema de la pared intestinal, evitar un grave síndrome de reperfusión, disminuir el estrés quirúrgico y anticipar las posibles complicaciones intraoperatorias. Los valores registrados de ácido láctico fueron elevados (6.2 milimoles/litro), probablemente debidos a la nutrición parenteral crónica. Conclusiones: La conducta anestésica utilizada ha conservado una adecuada estabilidad hemodinámica, además de optimizar el estado de la coagulación, mantener la temperatura central y equilibrar el estado ácido-base.

A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma

CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

Perforated tubercular enteritis of childhood: a ten year study.

One hundred sixty seven children were operated at the Kalawati Saran Children Hospital for acute peritonitis during last 10 years (1978-88). Bowel perforation was seen in 123 cases. Nineteen cases had underlying tubercular enteritis. Preoperative diagnosis was usually difficult. The terminal ileum was affected in 12 and the jejunum in 5 cases. Multiple perforations were seen in 3 cases. Postoperative mortality was high (12/19) and usually attributable to their poor preoperative status.