Eosinophilic mucosal infiltrate in infants with congenital gastrointestinal obstruction.

Infiltration of the antrum and small bowel with eosinophils has been reported to be the etiologic factor for intestinal obstruction in adults with eosinophilic gastroenteritis. We report a case of a breast-fed 8-month-old infant with eosinophilic gastroenteritis (EGE), who presented with severe hematemesis and congenital obstruction of the duodenum, to emphasize that not all obstructive symptoms associated with EGE are secondary to eosinophilic infiltration. Our patient displayed many of the classic signs and symptoms of EGE, including an elevated absolute eosinophil count and marked eosinophilic infiltration in mucosal biopsies from the duodenum, stomach, and esophagus. At surgery there was marked dilation of the first portion of the duodenum and obstruction of the second portion due to malrotation of the intestine with Ladd's bands, duodenal stenosis, and annular pancreas. The dramatic clinical response to surgical correction of the duodenal obstruction leaves little doubt that this patient's symptoms were related to the anatomical lesion.