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Case Reports
. 2024 Mar 2;11(3):e01292.
doi: 10.14309/crj.0000000000001292. eCollection 2024 Mar.

Eosinophilic Gastroenteritis Causing Pyloric Stenosis: A Rare Manifestation

Fei Yang Pan  1 , Matthew Smale  1 , Michael Rennie  1 , Rinky Langan  1 , Claudia Rogge  1
Affiliations
Case Reports

Eosinophilic Gastroenteritis Causing Pyloric Stenosis: A Rare Manifestation

Fei Yang Pan et al. ACG Case Rep J. .

Abstract

Eosinophilic gastritis is a gastrointestinal disorder characterized by eosinophilic infiltration in the gastric wall. We present a rare case of critical pyloric stenosis secondary to eosinophilic gastritis in a 16-year-old adolescent girl who presented with nausea, vomiting, early satiety, and abdominal pain. Abdominal computed tomography and subsequent esophagogastroduodenoscopy confirmed the anatomical diagnosis, but histological confirmation of the eosinophilic etiology was challenging. After an unsuccessful trial of high-dose systemic corticosteroids, a laparoscopic gastrojejunostomy was performed and long-term immunosuppression with mycophenolate mofetil was commenced.

Keywords: eosinophilic esophagitis; eosinophilic gastritis; eosinophilic gastroenteritis; gastric outlet obstruction; pyloric stenosis.

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Figures

Figure 1.
Figure 1.
Axial CT showing fluid-filled stomach with the thickened wall and tapering at the antrum and pylorus (red arrow) with the corresponding coronal view. CT, computed tomography.
Figure 2.
Figure 2.
(A) Severe erosive gastritis most pronounced in the antrum and a pyloric stenosis traversable only with a 5.4 mm diameter gastroscope. (B) Severe erosive gastritis with ulceration and progression of the pyloric stenosis that now precluded passage with the 5.4 mm gastroscope. (C) Third EGD on day 24 revealed a significant improvement in the inflammatory component, but persistent fibrotic antral changes. (D) Repeat EGD 4 weeks later revealed a patent gastrojejunostomy with a noninflamed but fibrous stenosis. EGD, esophagogastroduodenoscopy.
Figure 3.
Figure 3.
Histological image showing prominent eosinophil infiltration into the lamina propria of gastric mucosa. Eosinophil count is up to 50 per HPF, in greater than 5 HPFs. Focal intraepithelial eosinophilic infiltrates are seen. Eosinophils can be identified by orange granules and bilobed nuclei (red arrows). HPF, high-power field.
Figure 4.
Figure 4.
Histological image showing prominent eosinophil infiltration (red arrows) into the lining epithelium. Eosinophil count is up to 50 per HPF, in greater than 5 HPFs. HPF, high-power field.
See this image and copyright information in PMC

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