CT findings in eosinophilic enterocolitis with predominantly serosal and muscular bowel wall infiltration

A 44-year-old female presented with tenderness of her abdomen, vomiting, intestinal obstruction, hypoalbuminemia and blood eosinophilia. Gastroscopy was normal and colonoscopic biopsies showed only non-specific inflammation of the colonic mucosa and submucosa. CT revealed large amounts of ascites and bilateral pleural effusions but eosinophil counts in the ascites were normal. At CT the jejunum was dilated and showed marked prominence of the valvulae whereas the ileum and the colon presented with a diffuse and hypoattenuating bowel wall thickening. The bowel wall thickening was most pronounced in the colon which especially showed also an impressive thickening and hyperenhancement mainly of its outer bowel wall layers. Parasitic infection could be excluded as well as a specific allergic response. In context with the known blood eosinophilia the diagnosis of an eosinophilic enterocolitis was suspected already by CT but finally only surgical full thickness biopsies could confirm the rare diagnosis of an eosinophilic enterocolitis with predominantly serosal and muscular bowel wall infiltration.