Enterolithiasis complicating eosinophilic enteritis: A case report and review of literature

Eosinophilic enteritis requiring differentiation from chronic enteropathy associated with SLCO2A1 gene: A case report

BACKGROUND

Eosinophilic gastrointestinal disease (EGID) is a disorder characterized by infiltration of eosinophils causing mucosal damage and dysfunction of the gastrointestinal tract. The endoscopic findings of eosinophilic enteritis (EoN), an EGID variant, are nonspecific and occasionally difficult to diagnose. In contrast, chronic enteropathy associated with SLCO2A1 (CEAS) is a chronic persistent small intestinal disorder characterized by endoscopic findings such as multiple oblique and circular ulcers.

CASE SUMMARY

We report the case of a 10-year-old boy who had suffered abdominal pain and fatigue for the preceding 6 mo. He was referred to our institute for investigation of suspected gastrointestinal bleeding because of severe anemia with hypoproteinemia and positive fecal human hemoglobin. The upper and lower gastrointestinal endoscopic findings were normal; however, double-balloon small bowel endoscopy showed multiple oblique and circular ulcers with discrete margins and mild constriction of the intestinal lumen in the ileum. The findings were highly consistent with CEAS, but urine prostaglandin metabolites were within normal limits, and no previously reported mutations in the SLCO2A1 gene were identified. Histological evaluation demonstrated moderate to severe eosinophilic infiltration localized to the small intestine suggesting a diagnosis of EoN. Clinical remission was maintained with montelukast and a partial elemental diet, but emergent surgery for bowel obstruction due to small intestinal stenosis was performed two years after the initial treatment.

CONCLUSION

EoN should be considered in the differential diagnosis of CEAS-like small intestinal ulcerative lesions and normal urinary prostaglandin metabolite levels.

Eosinophilic enteritis with enteroliths: A diagnostic dilemma

Introduction and importance

Eosinophilic gastroenteritis (EG) is a rare disease, characterized by eosinophilic infiltration of different layers of intestinal wall. Thus having a wide spectrum of presentation leading to diagnostic dilemma.

Case presentation

We report a case of 55 years old female who presented with pain in abdomen, constipation, vomiting off and on with passage of stools on alternate days since 6 months. Plain radiographs showed radio-opaque densities in abdomen. Contrast enhanced computed tomography (CECT) of abdomen showed Ileal stricture with dilated proximal bowel loops with enteroliths. Exploratory laparotomy confirmed ileal stricture with thickening of the mesentery and an ileal diverticulum. Resection of ileal stricture was performed. The resected segment contained seven hard, black enteroliths. Histopathology of the resected specimen confirmed EG. Stone analysis showed dense faecal matter with bile salts.

Clinical discussion

EG leads to symptoms ranging from vomiting, abdominal pain, diarrhoea, blood loss in stools, anaemia to malabsorption resulting in diagnostic dilemma. It may cause gastrointestinal obstructive symptoms secondary to stricture, depending upon the predominant layer involved.

Conclusion

The differential diagnosis of EG should always be considered when dealing with gastroenteritis presenting with radio-opaque densities in abdomen.

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Eosinophilic Gastroenteritis (EG) is a rare disease with a wide spectrum of clinical presentation.

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Diagnosis of EG is often missed or delayed due to its overlapping findings with other GI disorders.

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Presentation of Eosinophilic Gastroenteritis with Enterolith is rare.

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Eosinophilic Gastroenteritis once diagnosed can be treated medically.

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However, once stricture or enteroliths are formed or there is intestinal obstruction, surgery is the mainstay of treatment.

Bile Salt Enterolith: An Unusual Etiology Mimicking Gallstone Ileus

Primary enterolithiasis is a relatively uncommon but important cause of small bowel obstruction. We present a case of a 69-year-old male with a history of laparoscopic Roux-en-Y gastric bypass and asymptomatic duodenal diverticulum diagnosed with small bowel obstruction. CT imaging showed an obstruction distal to the jejunojejunostomy, and surgical intervention was warranted. A 4.5 cm enterolith removed from the distal jejunum was found to contain 100% bile salts, consistent with a primary enterolith. Clinicians should retain a high index of suspicion for enteroliths as a cause of small bowel obstruction, especially if multiple risk factors for enterolith formation are present.

Subacute intestinal obstruction by enterolith: a case study

Introduction

Enteroliths are an uncommon entity in humans and form a rare cause of subacute intestinal obstruction. They occur proximal to stricture or in a diverticulum or a blind loop due to stasis.

Case description

40 years male presenting with intermittent right lower abdominal pain since 1 year. Barium meal follow-through and CT abdomen diagnosed as a case of subacute intestinal obstruction with an enterolith in the distal ileal segment. On exploratory laparotomy multiple ileal strictures with mesenteric adhesions were noted. An enterolith was delivered from one of the segments between two strictures followed by segmental resection of the pathological ileal segment with ileo-ileal anastomoses. Histopathology of the ileal segment showed inflammatory infiltrates.

Discussion and Evaluation

It was a case of a primary enterolith formed due to stasis between ileal strictures causing subacute intestinal obstruction.

Conclusion

An enterolith should also be considered while evaluating a case of intestinal obstruction as one of the rare differentials.