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18 April 2016 : Case report  Japan

A Case of Eosinophilic Gastroenteritis Forming a Rigid Chamber Mimicking Giant Duodenal Ulcer on Computed Tomography Imaging

Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Yoko ShimamotoABDEF, Yohei HarimaABDEF

DOI: 10.12659/AJCR.897403

Am J Case Rep 2016; 17:259-263

Abstract

BACKGROUND: The clinical manifestations of eosinophilic gastroenteritis are nonspecific and vary depending on which layer of the gastrointestinal tract is involved. Computed tomography (CT) is valuable for detecting and characterizing gastrointestinal wall abnormalities.

CASE REPORT: We report a case of eosinophilic gastroenteritis that formed a chamber in the rigid duodenal wall of a 67-year-old woman. Abdominal CT showed symmetrical wall thickening of the gastric antrum and duodenal bulb, and the bowel walls consisted of 2 continuous, symmetrically stratified layers. There was a chamber mimicking a giant ulcer at the orifice of the descending duodenum. Eosinophilic inflammation was present through this rigid wall of the descending duodenum, accompanied by perienteric inflammation, which infiltrated the anterior pararenal space, gall bladder, and right colic flexure. Gastrointestinal endoscopy showed spotty erosions and reddish mucosa, with the edematous gastric antrum and duodenal bulb narrowed at their lumens. Just beyond the supraduodenal angle at the orifice of the descending duodenum, there was a chamber with only minor mucosal changes, and it was not a duodenal ulcer. Endoscopic biopsy of the duodenum showed intramucosal eosinophilic infiltration. Treatment with prednisolone resulted in normalization of radiologic and endoscopic abnormalities.

CONCLUSIONS: We present a case of eosinophilic gastroenteritis with both mucosal and muscular involvement. CT imaging and endoscopic examination confirmed the diagnosis.

Keywords: Duodenal Ulcer - diagnosis, Diagnosis, Differential, Endoscopy, Gastrointestinal, Enteritis - diagnosis, Eosinophilia - diagnosis, Gastritis - diagnosis, Tomography, X-Ray Computed

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923