A surgical case of eosinophilic gastroenteritis presented difficulty in differentiating from advanced gastric cancer

Abstract

A 75-year-old woman consulted a neighboring doctor because of epigastric pain and weight loss of 7kg. Gastroendoscopy showed narrowing of the antrum and pylorus with edematous mucosa, and a mucosal biopsy resulted in Group IV. She was admitted to our hospital for further examination and treatment. Since it was difficult to rule out a possibility of malignancy and severe symptoms had still remained, an operation of distal gastrectomy with Roux-Y reconstruction and lymph nodes dissection (D2) was performed. The postoparative histopathological diagnosis was eosinophilic gastroenteritis of the stomach. Nodules on the anterior surface of the pancreas which was suspected of peritoneal dissemination of gastric cancer during surgery were clarified to be hyperplasia of pancreatic β cells.
Generally, eosinophilic gastroenteritis is a rare disease of unknown inflammatory etiology characterlized by eosinophilic infiltration of the total gastrointestinal tract. One of the characteristic clinical feature of this disease is peripheral eosinophilia, elevated serum immunoglobulin E, but this case showed no evidence of these findings in preoperative examinations. To the best of our knowledge, this is the 12th case report of eosinopilic gastroenteritis with gastric operation to be documented in Japan from 1983 to 2009.