Acute-onset of abdominal ...

A 53-year old woman presented to the emergency department with complaints of acute-onset of abdominal pain and vomiting. She did not receive any abdominal operation. The patient denied taking any drugs or herbal medicines. She had no history of drug allergy, asthma, or allergic rhinitis.

Examination

Physical examination revealed that her abdomen was slightly distended and rigid with tenderness. Laboratory investigation showed a white cell count of 10 800/mm3 with 3% eosinophils. Other laboratory studies were within normal limit. Abdominal radiograph displayed multiple air-fluid levels in the small intestine. Computed tomography demonstrated dilatation of the small intestine and ascites. With her abdominal distension and tenderness progressively worsening, emergency laparotomy was performed with a midline incision. Exploration revealed a large amount of yellowish ascites in the peritoneal cavity and focal stricture in the ileum about 60 cm proximal to the ileocecal valve. The remaining small bowel was dilated. Further inspection of the peritoneal cavity did not find any other abnormality. The stricture site was resected about 10 cm long and end to end anastomosis was performed. The mucosa of the specimen was edematous but there was no inflammation. Histologically, there was a dense infiltration of eosinophils throughout the entire thickness of ileal wall. Postoperatively, the patient’s stool was negative for ova and parasites and skin prick test was negative.