Eosinophilic ascites and duodenal obstruction in a patient with liver cirrhosis.

Nasrollah Maleki,Seiiedeh Samaneh Taghiyan Jamaleddin Kolaii,Mehrzad Bahtouee,Zahra Tavosi,Mohammadreza Kalantar Hormozi,Hamidreza Mosallai Pour

doi:10.1155/2014/928496

Abstract

Eosinophilic gastroenteritis (EG) is a rare disease characterized by eosinophilic infiltration of portions of the gastrointestinal tract. Eosinophilic ascites is probably the most unusual and rare presentation of EG and is generally associated with the serosal form of EG. Hereby, we report a case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis. A 50-year-old woman was admitted to our hospital because of abdominal pain, nausea, bloating, and constipation. She had a history of laparotomy because of duodenal obstruction 2 years ago. Based on clinical, radiological, endoscopic, and pathological findings, and given the excluding the other causes of peripheral eosinophilia, the diagnosis of eosinophilic gastroenteritis along with liver cirrhosis and spontaneous bacterial peritonitis was established. Based on the findings of the present case, it is highly recommended that, in the patients presented with liver cirrhosis associated with peripheral blood or ascitic fluid eosinophilia, performing gastrointestinal endoscopy and biopsy can probably reveal this rare disorder of EG.

Highlights

Eosinophilic gastroenteritis (EG) represents one member of a family of diseases that includes eosinophilic esophagitis, gastritis, enteritis, and colitis, collectively referred to as eosinophilic gastrointestinal disorders [1]
The diagnosis of EG is confirmed by a characteristic biopsy and/or eosinophilic ascitic fluid in the absence of infection by intestinal parasites or other causes of intestinal eosinophilia
The clinical features of EG are related to the layer(s) and extent of bowel involved with eosinophilic infiltration: mucosa, muscle, and/or subserosa [2]

Summary

Introduction

Eosinophilic gastroenteritis (EG) represents one member of a family of diseases that includes eosinophilic esophagitis, gastritis, enteritis, and colitis, collectively referred to as eosinophilic gastrointestinal disorders [1]. The diagnosis of EG is confirmed by a characteristic biopsy and/or eosinophilic ascitic fluid in the absence of infection by intestinal parasites or other causes of intestinal eosinophilia. The clinical features of EG are related to the layer(s) and extent of bowel involved with eosinophilic infiltration: mucosa, muscle, and/or subserosa [2]. Surgical series report a predominance of muscular disease with obstruction [3], while medical series primarily describe patients with mucosal involvement [4, 5]. The disease can affect patients of any age, but typical presentations are in the third through fifth decade with a male predominance [4, 6]. To the best of our knowledge, this is the first reported case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis from Iran

Case Presentation

Findings

Discussion

Conclusion