Eosinophilic Colitis Presenting as Hemoperitoneum: A Report of a Rare Case

Eosinophilic colitis (EC) is a rare clinical entity. Advanced cases with severe inflammation may develop severe abdominal pain and distension, malabsorption, intestinal obstruction, and even GI hemorrhage. Once diagnosed early, EC responds to steroid therapy. We report the case of a 46-year-old male who presented with acute-onset left upper abdominal pain, enlargement of the right scrotal sac, and hemoperitoneum. A contrast-enhanced CT scan of the abdomen revealed an irregular hypoechoic lesion measuring approximately 6.5 × 4.8 cm, likely a transverse mesocolon hematoma in the epigastric region with hemoperitoneum and right-sided hematocele with persistent processus vaginalis. USG-guided ascitic tap yielded bloody aspirate. Ascitic fluid analysis showed sheets of eosinophils (60%) with a hemorrhagic background. CBC showed eosinophilia (38%). He underwent diagnostic laparoscopy and laparoscopic left hemicolectomy; histopathological examination of the resected colon revealed EC (transmural type). He was given oral corticosteroids for two weeks after discharge. EC is a rare condition. It may present acutely and give rise to potentially severe and fatal complications like hemorrhage and perforation. With early diagnosis and appropriate treatment, we may be able to avoid serious complications in such patients.