EOSINOPHILIC GASTROENTERITIS - A RARE CAUSE OF INTESTINAL OBSTRUCTION

Abstract : Intestinal obstruction is one of the most common gastrointestinal emergencies in children attending pediatric gastroenterology clinic.Among the many causes that cause intestinal obstruction in children, one rare but a distinct clinical entity is eosinophilic enteritis which responds dramatically to steroids. We report 2 rare cases of Eosinophilic enteritis presenting as intestinal obstruction in children. The first case was a seven year old female who came with complaints of acute onset of vomiting, abdominal pain with abdominal distention, underwent laparotomy and resection on suspicion of intestinal obstruction, didnt improve and was referred to GE dept. On examination, she had generalised distention of abdomen with tenderness and normal bowel sounds. Routine investigations were done which were normal. Serum IgE levels were 444 IUs. Child was subjected to emergency re-laparotomy which revealed anastomotic stricture in distal Ileum with dilated proximal bowel. Resection of the diseased Ileum and end to end ileoileal anastomosis was done and specimen sent for histopathology which revealed inflammatory infiltrate with eosinophil more than 20HPF in mucosa and submucosa extending to serosa. Findings which were consistent with eosinophilic gastroenteritis. The child was started on oral steroids which were tapered over six months. During regular follow up she was found to be asymptomatic. The second case was that of a twelve year old male child who came with complaints of vomiting, abdominal pain and distention for one week. General examination revealed mild pallor with generalized distended tender abdomen with dilated loops. Routine investigations revealed eosinophilia. Serum IgE level was 923 IU. He was subjected to emergency laparotomy which revealed dilated jejunum and ileum with two ileal strictures at 15 and 20 cms from ileocaecal junction. Strictures were resected and ileoileal anastomosis was done and the resected segment was sent for histopathology which revealed eosinophils extending from mucosa to serosa. Findings which were consistent with eosinophilic gastroenteritis Post operative oral steroids were started and gradually tapered. He is on regular follow up and currently asymptomatic.