Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12709
Peer-review started: March 28, 2015
First decision: May 18, 2015
Revised: June 4, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: November 28, 2015
Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.
Core tip: We report a case of a perforated duodenal ulcer secondary to allergic eosinophilc gastroenteritis in a pediatric patient. To our knowledge this is the only reported case of spontaneous duodenal ulcer perforation in this patient population. Herein we discuss the details of our case, highlighting the need for increased suspicion of eosinophilic gastroenteritis (EGE) in pediatric patients with gastrointestinal ulcers. Further, we discuss the epidemiology, pathophysiology, and treatments of EGE, along with a review of the current literature.