Eosinophilic enteritis presenting as a perforated duodenal ulcer.

condition of unknown etiology that is characterized by eosinophilic infiltration in the layers of the gastrointestinal tract [1]. It can affect any part of the gastrointestinal tract but most commonly affects the stomach [1,2]. This report describes a rare case of EGE presenting as a perforated duodenal ulcer with subsequent duodenal stenosis. A 26-year-old manwas referred to us with duodenal obstruction following a laparotomy for a perforated duodenal ulcer. He had undergone repair of the ulcer and 2weeks later had presentedwithvomiting andweight loss. Endoscopy showedgastritis and a duodenal ulcer with stenosis (●" Fig. 1). A bariummeal showed narrowing at the first part of the duodenum (●" Fig. 2). Hewasgiven treatment forHelicobacter pylori and pantoprazole. A repeat endoscopy 2 months later showed a deformed pylorus, prepyloric nodular mucosa, and an almost circumferential duodenal ulcer with significant narrowing. Biopsies from the ulcer showed a marked eosinophilic infiltrate diagnostic of EGE (●" Fig. 3). He received prednisolone as a tapered course over 1 month and pantoprazole, after which, there was a marked improvement in his symptoms. A repeat endoscopy showed a healed duodenal ulcer and a postbulbar stricture (●" Fig. 4). Central radial expansion balloon dilation was performed. He received another course of steroids and 1 month later was well and gaining weight with no vomiting. Talley et al. suggested three diagnostic criteria for EGE: (i) gastrointestinal symptoms; (ii) demonstration of eosinophilic infiltration in the gastrointestinal tract, or presence of high eosinophil count in fluid; (iii) no evidence of parasitic or extraintestinal disease [3]. EGE has been classified, depending on the extent of bowel wall involvement, into mucosal, muscular, and serosal [1,3]. In the past, peptic ulceration accounted for most cases of gastric outlet obstruction. Nowadays, other causes such as malignancy and EGE must be excluded. EGE may also present acutely [4,5] as was the case for our patient who presented with peritonitis secondary to a perforated peptic ulcer, with a subsequent stricture Eosinophilic enteritis presenting as a perforated duodenal ulcer