A Rare Case of Eosinophilic Gastroenteritis and Ampullitis Leading to Benign Papillary Stenosis

Akwe Nyabera,Saphwat Eskaros,Nso Nso,Negar Niknam,Keya Shah,Hirotada Akiho

doi:10.1155/2021/5597578

Abstract

Eosinophilic gastroenteritis is characterized by eosinophilic infiltration of the gastrointestinal wall. There have been limited studies of eosinophilic infiltration involving the ampulla. We present a 70-year-old woman with a history of asthma, eosinophilic esophagitis, and eosinophilic sinusitis, who underwent work up for postprandial abdominal pain and abnormal liver function tests. The patient had various imaging studies done, including computed tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP). Dilated extrahepatic bile duct with distal tapering towards the ampulla was noted on MRCP and afterwards on endoscopic ultrasound (EUS). Endoscopic retrograde cholangiopancreatography (ERCP) revealed an inflamed major ampulla with benign papillary stenosis. The patient was treated with sphincterotomy, sphincteroplasty/dilation of distal common bile duct, and placement of an 11.5 Fr × 7 cm plastic stent into the bile duct. Additionally, she was started on prednisone, which was gradually tapered down. The patient demonstrated significant improvement with systemic steroid therapy. Liver function tests (LFTs) completely normalized after ERCP. Ampullitis leading to papillary stenosis secondary to eosinophilic infiltration of the major papilla is a rare manifestation of eosinophilic gastrointestinal disorders (EGIDs). Early diagnosis would lead to appropriate medical and endoscopic management.

Highlights

Eosinophilic gastroenteritis is characterized by eosinophilic infiltration of the gastrointestinal wall [1, 2]. e stomach and small intestine are the most commonly affected organs [3, 4]. ere have been limited studies of eosinophilic infiltration involving the ampulla
We present a patient with abnormal liver function tests and abdominal pain who was found to have benign papillary stenosis secondary to eosinophilic infiltration of the major papilla. e clinical presentation of eosinophilic gastroenteritis varies widely
We present a rare case of eosinophilic infiltration of the major ampulla which resulted in benign papillary stenosis

Summary

Introduction

Eosinophilic gastroenteritis is characterized by eosinophilic infiltration of the gastrointestinal wall [1, 2]. e stomach and small intestine are the most commonly affected organs [3, 4]. ere have been limited studies of eosinophilic infiltration involving the ampulla. Eosinophilic gastroenteritis is characterized by eosinophilic infiltration of the gastrointestinal wall [1, 2]. Ere have been limited studies of eosinophilic infiltration involving the ampulla. We present a patient with abnormal liver function tests and abdominal pain who was found to have benign papillary stenosis secondary to eosinophilic infiltration of the major papilla. E clinical presentation of eosinophilic gastroenteritis varies widely. Eosinophils are inhabitants of the gastrointestinal mucosal lining delivering a natural defense in cases of parasitic infections [2]. Multiple biopsies may be required due to the variable nature of the disease [2]. Eosinophilic gastroenteritis is a substantially treatable disease with the elimination of empirical food diets. Treatment is largely dependent on the severity of symptoms and extent of disease [7]

Case Presentation

Findings

Discussion