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Abdominal ascites in children as the presentation of eosinophilic gastroenteritis: A surgeon's perspective
Lan-Jie Cheng1, Shu-Cheng Zhang1
1Department of Pediatric Surgery, Shengjing Hospital of China Medical University, 36, Sanhao Street, Heping district, Shenyang 110004, PR China.
Insights
Eosinophilic gastroenteritis (EG) is a rare cause of abdominal ascites in children. Surgeons should consider EG in pediatric patients with allergies and eosinophilia, as dietary changes and medication can effectively treat this condition.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Allergy and Immunology
Background:
- Abdominal ascites is a common surgical issue with diverse causes.
- Eosinophilic gastroenteritis (EG) is an infrequent cause of ascites, typically reported in adults.
- This study focuses on pediatric cases of eosinophilic ascites from a surgical viewpoint.
Observation:
- Five children with EG presented with symptoms including abdominal pain, diarrhea, nausea, distension, and fever.
- Three patients had a history of allergic disease.
- Peripheral eosinophilia and elevated IgE levels were noted in most cases, with ascites confirmed by imaging.
Findings:
- Two patients underwent surgical intervention.
- All children achieved full clinical remission through dietary control and methylprednisolone treatment.
- Long-term follow-up indicated positive outcomes for all patients.
Implications:
- Surgeons must recognize EG as a potential cause of ascites in children, particularly those with allergic histories.
- Early diagnosis and non-surgical management (dietary modification, corticosteroids) can prevent unnecessary surgical procedures.
- Awareness of EG in pediatric ascites can lead to timely and effective treatment, improving patient outcomes.
Background:
Abdominal ascites is a common problem in general surgery. The causes include parasitic diseases, tuberculosis, malignancies, hypoalbuminemia, abdominal inflammatory diseases, and peritonitis. Eosinophilic gastroenteritis (EG) has also been reported to be an infrequent cause. To our knowledge, most instances of abdominal ascites from EG have occurred in adults and been reported by physicians or gastroenterologists. Herein, we report a small series of children who presented with eosinophilic ascites from a surgeon's perspective.
Methods:
Five children with EG (male: 3; female: 2) were selected for review of medical data and diagnostic reports.
Results:
The patients typically presented with intermittent abdominal pain (n = 5), diarrhea and nausea (n = 2), abdominal distension (n = 2), fever (n = 2), and histories of allergic disease (n = 3). Peripheral eosinophilia was regularly noted, three children showing elevated IgE levels. Abdominal ultrasound and CT performed in each instance demonstrated abdominal ascites. Surgical intervention was elected in two patients. Dietary control and a methylprednisolone regimen were then instituted in all children, followed by full clinical remissions. After a regular follow-up, all patients are doing well.
Conclusions:
Surgeons should be aware of EG as a rare cause of ascites, even in a pediatric population and especially in children with strong histories of allergic diseases, peripheral blood eosinophilia, and/or family histories of EG. It is important to avoid unnecessary surgical intervention, because dietary control and methylprednisolone treatment are effective remedies.
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