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Eosinophilic Ascites and Duodenal Obstruction in a Patient with Liver Cirrhosis

DOI: 10.1155/2014/928496

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Abstract:

Eosinophilic gastroenteritis (EG) is a rare disease characterized by eosinophilic infiltration of portions of the gastrointestinal tract. Eosinophilic ascites is probably the most unusual and rare presentation of EG and is generally associated with the serosal form of EG. Hereby, we report a case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis. A 50-year-old woman was admitted to our hospital because of abdominal pain, nausea, bloating, and constipation. She had a history of laparotomy because of duodenal obstruction 2 years ago. Based on clinical, radiological, endoscopic, and pathological findings, and given the excluding the other causes of peripheral eosinophilia, the diagnosis of eosinophilic gastroenteritis along with liver cirrhosis and spontaneous bacterial peritonitis was established. Based on the findings of the present case, it is highly recommended that, in the patients presented with liver cirrhosis associated with peripheral blood or ascitic fluid eosinophilia, performing gastrointestinal endoscopy and biopsy can probably reveal this rare disorder of EG. 1. Introduction Eosinophilic gastroenteritis (EG) represents one member of a family of diseases that includes eosinophilic esophagitis, gastritis, enteritis, and colitis, collectively referred to as eosinophilic gastrointestinal disorders [1]. Despite its rarity, EG needs to be recognized by the clinician because this treatable disease can masquerade as irritable bowel syndrome. The diagnosis of EG is confirmed by a characteristic biopsy and/or eosinophilic ascitic fluid in the absence of infection by intestinal parasites or other causes of intestinal eosinophilia. The clinical features of EG are related to the layer(s) and extent of bowel involved with eosinophilic infiltration: mucosa, muscle, and/or subserosa [2]. The prevalence of each subtype is unknown because of reporting and referral biases. Surgical series report a predominance of muscular disease with obstruction [3], while medical series primarily describe patients with mucosal involvement [4, 5]. The disease can affect patients of any age, but typical presentations are in the third through fifth decade with a male predominance [4, 6]. To the best of our knowledge, this is the first reported case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis from Iran. 2. Case Presentation A 50-year-old woman was admitted to our hospital in August 2011 because of abdominal pain, abdominal distension, nausea, bloating, and constipation. She had been experiencing recurrent

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