Eosinophilic enteritis presenting as acute abdomen: US features of two cases

Eosinophilic gastroenteritis presenting as acute abdomen

Many causes of acute abdomen are diagnosed on computed tomography (CT). We present two cases of eosinophilic gastroenteritis that showed mural thickening of the stomach, duodenum, and/or proximal jejunum on CT. The correct diagnosis was made by checking the eosinophil count, and, in one case, unnecessary surgery was avoided.

Sonography in diagnosis and follow-up of serosal eosinophilic gastroenteritis treated with corticosteroid

An 18-year-old patient presented with abdominal pain, nausea, and low-grade fever. Sonography showed ascites in the region of the terminal ileum, and the presence of peritoneal nodules suggested peritoneal inflammation. Cytologic analysis of ascites revealed numerous eosinophils. Sonographic visualization of nodular peritoneal deposits associated with eosinophilic ascites permitted the diagnosis of the serosal form of eosinophilic gastroenteritis. The absence of mucosal and muscular involvement in the bowel wall was confirmed by endoscopy and CT. Two weeks of 20 mg/day oral prednisolone led to relief of the patient's symptoms, with normalization of laboratory parameters and sonographic findings.

Nonmucosal eosinophilic gastroenteritis: sonographic appearance at presentation and during follow-up of response to prednisone therapy

This case describes the sonographic appearance of eosinophilic gastroenteritis before and during prednisone treatment. The dramatic clinical and sonographic response to prednisone therapy confirmed the diagnosis. Sonography is a quick, low-cost, and noninvasive means of diagnosing eosinophilic gastroenteritis and together with other clinical, laboratory, and endoscopic data may prevent unnecessary and potentially dangerous abdominal surgery.

Imaging and intervention in patients with acute right lower quadrant disease

US using graded compression plays a central role in the diagnostic work-up of acute right lower quadrant disease, but its results should always be integrated with clinical data and results of other possible radiological examinations. Direct US visualization of an inflamed appendix is solid proof of appendicitis. Pitfalls are secondary enlargement in perforated peptic ulcer, caecal carcinoma or Crohn's disease. If a normal appendix is visualized in its full length, appendicitis can be excluded. However, this is rarely the case. In practice, the only means to exclude appendicitis is to demonstrate an alternative condition, which in most cases is possible by US alone. Concomitant adynamic ileus is a valuable US finding. Abscesses related to appendicitis, Crohn's disease and colonic carcinoma respond well to percutaneous drainage, which is technically possible in 95% of cases. Some of these abscesses evacuate spontaneously to neighbouring bowel. For abscesses due to caecal diverticulitis spontaneous evacuation to the caecal lumen is the rule. For indication and drainage strategy, integration of US, CT and clinical data are indispensable. The use of US in right lower quadrant disease will not only lead to a strong improvement of diagnostic accuracy, but also to better understanding of the incidence and natural course of various conditions such as abortive appendicitis, appendiceal abscess, caecal diverticulitis, bacterial ileocaecitis and right-sided segmental infarction of the omentum.