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.