Eosinophilic gastroenteritis in a child with gastric outlet obstruction mimicking superior mesenteric artery syndrome

ABSTRACT

Eosinophilic gastroenteritis (EGE) is known to have a low incidence among the pediatric population, but it can result in serious complications, such as gastric outlet obstruction. In previously published EGE cases with the obstruction in adults, surgeries were often performed. In this report, we present a 14-year-old girl who came to our facility with severe abdominal pain and vomiting. On the initial abdominal physical examination, diffuse tenderness and severe epigastric pain were noted. Computed tomography scan of the abdomen showed the findings of superior mesenteric artery (SMA) syndrome. However, she had no history of recent weight loss, and the medical history was inconsistent with SMA syndrome. We planned upper gastrointestinal series with barium, and then verified gastric outlet obstruction. We performed esophagogastroduodenoscopy and obtained a final diagnosis of EGE through mucosal biopsy specimen. Corticosteroids and anti-inflammatory medications were administered. Dietary modification and education were done as well. The symptoms resolved, and the follow-up esophagogastroduodenoscopy and ultrasonography showed improvements in the obstruction. Our case emphasizes that gastric outlet obstruction due to EGE must be carefully differentiated from SMA syndrome because of their similarities in clinical features and radiologic images. In doing so, we can avoid surgical intervention and perform medical/dietary treatment for gastric outlet obstruction.