Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12709-12712
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12709
Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis
Kevin M Riggle, Ghassan Wahbeh, Elizabeth M Williams, Kimberly J Riehle
Kevin M Riggle, Kimberly J Riehle, Department of General Surgery, University of Washington, Seattle, WA 98195, United States
Ghassan Wahbeh, Division of Gastroenterology, Seattle Children’s Hospital, Seattle, WA 98195, United States
Elizabeth M Williams, Division of Pathology, Seattle Children’s Hospital, Seattle, WA 98195, United States
Kimberly J Riehle, Division of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, WA 98195, United States
Author contributions: Riggle KM, Wahbeh G, Williams EM, and Riehle KJ contributed equally to this work.
Institutional review board statement: This study was reviewed and approved by the Seattle Children’s Hospital Institutional Review Board.
Informed consent statement: Informed consent was waived as approved by the Seattle Children’s Hospital Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Kimberly J Riehle, MD, Assistant Professor, Department of Surgery, University of Washington, Box 356410, Seattle, WA 98195, United States.
Telephone: +1+206-9872794 Fax: +1+206-9873925
Received: March 26, 2015
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.

Keywords: Pediatric, Duodenal ulcer, Eosinophilic, Gastroenteritis, Food allergies

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.