Duodenal-Jejunal Stenosis as a Manifestation of Eosinophilic Gastroenteritis: A Case Report

Introduction: Eosinophilic gastroenteritis (EGE) is a rare disorder characterized by eosinophilic infiltration of the stomach and small intestine. Its clinical manifestations depend on the extent, location, and depth of the inflammatory infiltrate. The pathogenesis remains unclear, but it may be related to food allergy or other hypersensitivity reactions in some patients. Untreated cases can cause intestinal stricture or perforation, making timely diagnosis and intervention essential. Clinical case: A 13-year-old male adolescent was hospitalized due to symptoms suggesting intestinal obstruction or alterations in intestinal motility. Medical imaging revealed significant gastric distension and delayed gastric emptying. An endoscopic study showed a “snake-skin” pattern, duodenitis due to food stasis, a 2 cm ulcer, and stenosis in the duodenum. The biopsy confirmed EGE with significant irregular eosinophilic infiltration of the lamina propria. A panendoscopy was performed after steroid treatment without being able to assess the site of stenosis and perform pneumatic dilation. After completing the immunomodulatory management, a contrast-enhanced abdominal tomography was performed showed a significant decrease in the intestinal lumen, therefore an exploratory laparotomy with a lateral to lateral jejune-jejunal anastomosis was performed. Discussion: EGE is a rare inflammatory disorder characterized by eosinophilic infiltration of the stomach and small intestine. Symptoms are based on the affected gastrointestinal tract segment. In this case, our patient presented intestinal obstruction symptoms with endoscopic biopsies and a histopathological study confirmed eosinophil infiltration. Treatment typically involves identifying potential triggers and corticosteroids to reduce inflammation and symptoms. However, in this case, a decrease in the intestinal lumen was observed, therefore an elective surgical resection was performed. Conclusion: Eosinophilic gastroenteritis is a rare disorder that requires strong clinical suspicion to be diagnosed, which is why its knowledge is important. In this case, gastrointestinal symptoms, radiological and endoscopic images, in addition to the histopathological report, were key tools for integrating the diagnosis. Although management with steroids and immunomodulators was not successful, surgical management became an appropriate option as definitive treatment.