Unusual case of subacute intestinal obstruction due to eosinophilic enteritis with enteroliths

Abstract

A 42-year-old female was admitted with complaints of colicky abdominal pain and bilious vomiting of 1 day duration. On examination, her vital parameters were within normal limits. Abdominal examination showed a distended abdomen with sluggish bowel sounds. Her hematological parameters were within normal limits. An erect and supine X-ray of her abdomen revealed few air fluid levels involving the small bowel. There were multiple radiopaque shadows seen in the pelvis [ Figure 1]. Ultrasonography of the abdomen showed small bowel loops with sluggish peristalsis and a single gall bladder calculi of 15 mm. A computed tomography (CT) scan with i.v. and oral contrast was done to rule out gall stone ileus. CT scan revealed features of subacute intestinal obstruction along with enteroliths in the lumen of the small bowel and cholelithiasis [ Figure 2]. Patient was kept nil by mouth and started on intravenous fluids. A Ryle's tube was inserted and the patient was monitored without any surgical intervention. The patient showed significant improvement on the next SUMMARY Eosinophilic enteritis is an uncommon disease characterized by eosinophilic infiltration involving any layer of the bowel wall. It can affect any area of gastrointestinal tract although stomach and small intestine are sites most frequently involved. It is important to recognize this disease and institute the necessary treatment at the earliest in order to avoid its complications. We present a case where the patient presented with features of subacute intestinal obstruction due to distal ileal strictures and enteroliths. Histopathologic examination of the resected specimen revealed characteristic features of eosinophilic enteritis.

Subacute intestinal obstruction by enterolith: a case study

“…Primary enteroliths are formed in the small bowel and secondary enteroliths are formed in gallbladder as gallstones. (Yadav et al 2015 ) True enteroliths of small intestine can be of 3 types depending on their composition—(1) those consisting of mainly bile acids, (2) those consisting of mainly phosphates, (3) those consisting of mainly calcium oxalate (D’souza et al 2010 ; Shivathirthan et al 2009 ). False endogenous enteroliths are common than true enterolith (Singleton 1970 ).…”

“…Stasis is an important factor in their production (Yadav et al 2015 ). Enteroliths were first described by Pfahler and Stamm in 1915 (D’souza et al 2010 ). Here we present a case of subacute intestinal obstruction with multiple strictures and enterolith in the distal ileum, who underwent segmental ileal resection and ileo-ileal anastomoses.…”

Enterolithiasis

“…Variations in structural integrity of the intestine may be seen in the diverticular disease (congenital and acquired) [8,9] ; surgical entero-anastomoses [14] , afferent or Roux loops [10] , blind pouches [13] ; stricturing or stenosing disease of the bowel seen in infectious and inflammatory conditions (tuberculosis, Crohn's disease) [11,12] ; radiation or eosinophillic enteritis [15,51] ; mucosal diaphragmatic disease [52] ; intestinal duplication [53,15] ; fistula [54] ; malignancy [55] ; and finally in apparent kinking of the gut that is found in patients with intra-abdominal adhesions, external compressions, or incarcerated hernias [15][16][17][18] . Other conditions associated with increased risk of enterolith production include intestinal aganglionosis, intestinal amoebiasis, and ischemic enteritis [15] .…”

Unusual Presentation of Eosinophilic Enteritis as Multiple Strictures of Small Intestine

“…Eosinophilic enteritis is an extremely rare disease, involving the entire gastrointestinal tract (GIT), although stomach and duodenum are frequently involved sites. 1 The pathogenesis and etiology of eosinophilic enteritis remains unclear. 2 It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract, 2 and enteritis occurs if there is involvement of the submucosal layer of the GIT.…”

“…The defect in mucosal integrity may be responsible for localization of various antigens in the gut wall resulting in infiltration of eosinophils in blood and tissues. 1 Eosinophil through toxic cationic protein plays a role in the pathogenesis of this disease. Diagnostic criteria include demonstration of eosinophilic infiltration in the bowel walls, lack of evidence of extraintestinal disease, and exclusion of various disorders that mimic a similar condition.…”