title: Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis.
abstract: Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.
authors.affiliation: Kevin M Riggle, Kimberly J Riehle, Department of General Surgery, University of Washington, Seattle, WA 98195, United States.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Riggle
authors.affiliation: Kevin M Riggle, Kimberly J Riehle, Department of General Surgery, University of Washington, Seattle, WA 98195, United States.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Wahbeh
authors.affiliation: Kevin M Riggle, Kimberly J Riehle, Department of General Surgery, University of Washington, Seattle, WA 98195, United States.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Williams
authors.affiliation: Kevin M Riggle, Kimberly J Riehle, Department of General Surgery, University of Washington, Seattle, WA 98195, United States.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Riehle
mesh_terms: D000293:Adolescent; D001706:Biopsy; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004384:Duodenoscopy; D004751:Enteritis / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology*; D004802:Eosinophilia / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology*; D005512:Food Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy; D005756:Gastritis / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology*; D005759:Gastroenteritis / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Duodenal ulcer; Eosinophilic; Food allergies; Gastroenteritis; Pediatric