Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2016; 8(9): 656-659
Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.656
Eosinophilic ascites: A diagnostic and therapeutic challenge
Shefali Agrawal, Sandeep Vohra, Sangeeta Rawat, Vikas Kashyap
Shefali Agrawal, Hepatobiliary and Pancreatic Surgery, Department of Surgical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
Sandeep Vohra, Department of Radiology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
Sangeeta Rawat, Vikas Kashyap, Department of Pathology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
Author contributions: Agrawal S contributed to study conception and design and drafting of manuscript; Agrawal S, Vohra S, Rawat S and Kashyap V contributed to acquisition of data and critical revision.
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Conflict-of-interest statement: None.
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Correspondence to: Shefali Agrawal, MD, MS, FACS, Senior Consultant, Hepatobiliary and Pancreatic Surgery, Department of Surgical Oncology, Indraprastha Apollo Hospitals, Delhi Mathura Road, Sarita Vihar, New Delhi 110076, India. shefali_a@apollohospitals.com
Telephone: +91-81-30009660
Received: May 24, 2016
Peer-review started: May 25, 2016
First decision: July 6, 2016
Revised: July 12, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: September 27, 2016
Abstract

Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract. Depending on the dominant layer of infiltration it is classified into three types namely, mucosal, muscularis and subserosal. The most uncommon variant is the subserosal type characterized by primarily subserosal disease, eosinophilic ascites and peripheral hypereosinophilia. The clinical features are non-specific with history of atopic predisposition and allergy. Endoscopic biopsy is frequently non-diagnostic due to an uninvolved gastrointestinal mucosa rendering its diagnosis a challenge. The mainstay of diagnosis is peripheral hypereosinophilia and eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid therapy is usually the first line of treatment with dramatic response. Due to a propensity for relapse, steroid-sparing therapy should be considered for relapses of EGE. We report a case of subserosal EGE with diagnostic clinical features and treatment response and review the current strategy in the management of eosinophilic ascites.

Keywords: Gastrointestinal, Atopy, Eosinophilic ascites, Endoscopic biopsy, Eosinophilia

Core tip: Eosinophilic gastroenteritis (EGE) is a rare condition and the diagnosis of subserosal EGE is challenging due to its nonspecific symptoms and signs and frequently non-diagnostic biopsy on gastrointestinal endoscopy. This review describes a patient with typical findings of peripheral hypereosinophilia and eosinophilic ascites and outlines the current strategy in the diagnosis and treatment of subserosal EGE.