青少年罕见嗜酸性粒细胞性胃肠炎伴腹水1例并文献复习

A Rare Case Report of Eosinophilic Gastroenteritis in Adolescent with Ascites and Literature Review

摘要: 探讨嗜酸性粒细胞性胃肠炎(EG)的临床表现、胃镜和肠镜下改变及病理特点，以提高临床医生对EG的认识。现报道我院于2019年5月诊治的一例青少年嗜酸性粒细胞胃肠炎伴腹水病例，并结合文献复习。患者为青少年男性，因腹痛3天入院，伴恶心、呕吐，伴腹胀，入院后查外周血嗜酸性粒细胞异常增高，行胃肠镜检查可见胃肠道粘膜充血、水肿、糜烂等改变，以十二指肠降段、回肠末端、乙状结肠、直肠炎症较重，病理示嗜酸性粒细胞浸润，且局灶嗜酸性粒细胞 ≥ 20个/Hp，该青少年诊断为嗜酸性粒细胞胃肠炎，经抗过敏、口服甲泼尼龙治疗后症状缓解，1周后复查腹部B超未见腹腔积液，2周后复查外周血嗜酸性粒细胞降至正常，症状好转后出院，出院后随访至今未再复发。EG临床表现及实验室检查缺乏特异性，临床容易误诊。对于患儿出现腹痛、恶心、呕吐等症状，要注意是否存在嗜酸性粒细胞增多，及时行胃肠镜检查以明确诊断，并排除其他可引起嗜酸性粒细胞增多性疾病，减少漏诊及误诊。

Abstract: To investigate the clinical feature, manifestation of gastroscopy and enteroscopy, and pathological features of endoscopic gastrojejunostomy in high gastrointestinal fistula, so as to provide guidance for the improvement of endoscopic gastrojejunostomy (EG). We report a case of juvenile eosinophilic gastroenteritis with ascites diagnosed and treated in our hospital in May 2019, and review with literature. The adolescent patient was a boy and was admitted to the hospital due to abdominal pain for 3 days, with nausea, vomiting, and abdominal distension. After admission, the peripheral blood eosinophils were abnormally increased. Gastrointestinal examination showed changes in gastrointestinal mucosa hyperemia, edema, erosion, etc, with severe in the descending duodenum, terminal ileum, sigmoid colon, and rectum. Pathology showed infiltration of eosinophils, and focal eosinophils ≥ 20/Hp. The adolescent patient was diagnosed with EG, and the symptoms were relieved after treatment with anti-allergy and oral methylprednisolone. After 1 week, bdominal fluid was not seen on B-mode ultrasound. After 2 weeks, peripheral blood eosinophils reduced to normal. The adolescent patient discharged after symptoms improved. We followed up The adolescent patient for 1 year after discharge, no recurrence. The clinical manifestations and laboratory tests of EG lack specificity and are easily misdiagnosed clinically. For children with abdominal pain, nausea, vomiting and other symptoms, pay attention to the presence of eosinophilia, timely gastroscopy to confirm the diagnosis, and exclude other diseases that can cause eosinophilia, reduce missed diagnosis and misdiagnosis.