Terminal ileal stricture caused by eosinophilic gastroenteritis: a postoperative histopathological finding

Abstract

Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic infiltration of one or more segments of gastrointestinal tract. Stricture formation is one of the uncommon occurrences seen in the muscular and serosal type of the disease. Stricturing disease of oesophagus, pylorus and proximal small bowel has been reported earlier. We report a rare case of 48 year old male presenting with intestinal obstruction due to stricture formation in the terminal ileum. CECT of abdomen showed a segmental stricture of terminal ileum. Intraoperatively multiple dense adhesions were seen around ileocaecal junction along with a strictured segment in the terminal ileum. Initially the diseased ileal segment was resected followed by an end ileostomy with a distal mucous fistula. The histopathological examination of the resected sample revealed ulcerated and edematous ileal mucosa with dense inflammatory cells rich in eosinophils infiltrating lamina proparia, muscularis proparia and serosal layer. After a month of the first surgery, a right hemicolectomy with end to end ileotransverse anastomoses was done as a definitive procedure. Patient was put on oral glucocorticoid regimen. He has been asymptomatic during the follow up period of 6 months.