Korean J Radiol.  2008 Jun;9(3):275-278. 10.3348/kjr.2008.9.3.275.

Enterobiliary Fistula as a Complication of Eosinophilic Gastroenteritis: a Case Report

• Kim HM
• Woo JY

• KMID: 1758462
• DOI: http://doi.org/10.3348/kjr.2008.9.3.275

Abstract

Eosinophilic gasteroenteritis is an uncommon disease with variable clinical features characterized by eosinophilic infiltration. Clinical manifestations range from non-specific gastrointestinal complaints such as nausea, vomiting, crampy abdominal pain, and diarrhea to specific findings such as malabsorption, protein loosing enteropathy, luminal obstruction, eosinophilic ascites and effusion. We report here on a case of eosinophilic gastroenteritis causing enterobiliary fistula which is an extremely unusual complication.

Keyword

Eosinophilic gastroenteritis; Enterobiliary fistula; Gastrointestinal tract, inflammation; Magnetic resonance (MR); Cholangiopancreatography

MeSH Terms

Aged
Biliary Fistula/diagnosis/*etiology
Cholangiopancreatography, Magnetic Resonance
Duodenal Diseases/*etiology
Eosinophilia/complications
Gastroenteritis/*complications
Humans
Intestinal Fistula/diagnosis/*etiology
Male

Figure

• 

  Fig. 1 Enterobiliary fistula in 68-year-old man. A. Axial enhanced multidetector CT scan shows thickening of gastric wall (white arrows) and air in gall bladder (white arrowheads). B. Coronal multiplanar reformatted multidetector CT image demonstrates pneumobilia (white arrows) and bezoar at duodenal bulb (white arrowheads). C. Gastrointestinal endoscopy demonstrates bezoar (white arrows) and geographic ulceration at duodenal bulb (black arrowheads). D. MR cholangiopancreatography coronal image of single-shot turbo spin-echo sequence shows linear high signal intensity from duodenal bulb to gall bladder, which is thought to be cholecystoduodenal fistula (black arrowheads). There is another area of faint linear high signal intensity, suggesting choledocoduodenal fistula (black arrows). E. Upper GI reveals mucosal fold thickening and nodularity in antrum of stomach (white arrowheads) and severe narrowing involving second portion of duodenum (black arrows). F. There are two linear structures (black arrows and black arrowheads) that originate from duodenal bulb. We can not trace definite connection to biliary system, but they are thought to be enterobiliary fistulas. G. Microscopic finding shows marked eosinophilic infiltration (over 70 eosinophils/HPF) in lamina propria of gastric mucosa (black arrowheads) (Hematoxylin & Eosin staining, × 400).

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