Eosinophilic Enteritis Presenting with Recurrent Abdominal Pain and Bowel Obstruction in the Absence of Peripheral Eosinophilia: A Rare Case Report

Background Eosinophilic enteritis is a rare subtype of eosinophilic gastrointestinal disorders characterized by eosinophilic infiltration of the small intestine. Clinical presentation varies according to the depth of bowel wall involvement. Muscularis-predominant disease is exceptionally uncommon and frequently lacks peripheral eosinophilia, which poses considerable preoperative diagnostic difficulty. Case presentation A 23-year-old woman presented with acute severe upper-quadrant abdominal pain, nausea, and vomiting, on a background of three similar hospitalizations over two years without a definitive diagnosis. Imaging showed segmental ileal narrowing with proximal small-bowel dilatation and ascites. Laboratory testing revealed leukocytosis without peripheral eosinophilia. Because of persistent obstruction, a limited right hemicolectomy with ileal resection was performed. Histopathology demonstrated dense eosinophilic infiltration (markedly increased, exceeding 50 eosinophils per high-power field) predominantly involving the muscularis propria and subserosa, with preserved mucosa. Peritoneal biopsies showed eosinophilic inflammation. Malignancy, tuberculosis, vasculitis, and parasitic infection were excluded. Postoperative recovery was uneventful. Conclusion Eosinophilic enteritis should be considered in the differential diagnosis of recurrent abdominal pain and small-bowel obstruction, even when peripheral eosinophilia is absent. Histopathological examination is essential for definitive diagnosis, and awareness is particularly important in resource-limited settings where advanced diagnostic modalities are unavailable.