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| Year : 1986 | Volume
: 32
| Issue : 3 | Page : 171-2,170B |
Eosinophilic granulomatous polyp and intussusception (a case report).
Dalvi AN, Shenoy SG, Satoskar RR, Vora IM, Candes FP
How to cite this article:
Dalvi A N, Shenoy S G, Satoskar R R, Vora I M, Candes F P. Eosinophilic granulomatous polyp and intussusception (a case report). J Postgrad Med 1986;32:171-2,170B |
How to cite this URL:
Dalvi A N, Shenoy S G, Satoskar R R, Vora I M, Candes F P. Eosinophilic granulomatous polyp and intussusception (a case report). J Postgrad Med [serial online] 1986 [cited 2023 Sep 25];32:171-2,170B. Available from: https://www.jpgmonline.com/text.asp?1986/32/3/171/5331 |
This is a report of submucosal ileal granuloma with eosinophilic infiltration resulting in intussusception and intestinal obstruction. In review of available literature only 96 cases of eosinophilic granuloma of gastro-intestinal tract were found.
A 55 year old male was admitted with intermittant attacks of colicky pain, distension and constipation. His vital parameters were normal. Abdominal examination revealed distension with hyperperistalsis. Rectal examination was normal. Abdominal radiograph revealed multiple air-fluid levels. Hemogram was normal.
The patient was treated conservatively with nasogastric suction and intravenous alimentation for two days. Exploratory laparatomy was done when the. patient did not respond to conservative treatment. This revealed an ileo-ileal intussusception, 10 cm long, 30 cm away from the ileocaecal junction with dilated proximal bowel. Reduction of intussusception revealed the presence of pedunculated mass in the ileum for which resection and anastomosis were done. Postoperative course was uneventful.
The resected segment was 22 cm long and revealed a pedunculated ovoid mass 5 x 3 x 2 cm, arising from the anti-mesenteric border of the ileum tissue [Fig. 1]. Cut surface was oedematous and homogenous white with foci of congestion.
Microscopically, the mass was composed of loose connective tissue with rich vascular network. The abundant oedematous stroma consisted of moderate number of spindle shaped fibroblasts intermingled with inflammatory cells of which eosinophils formed a noticeable portion [Fig 2].
Eosinophilic granuloma of the gastrointestinal tract affects the gastric antrum. Constant or intermittent abdominal pain, vomiting and weight loss may be present for weeks or months. Occasionally, the patient may present with intestinal obstruction due to intussusception as in our case.
Vaneck[7] was the first to describe the lesion as a distinct entity. He coined the term "Gastric submucosal granuloma with eosinophilic infiltration". Two forms of lesions have been described[2]: diffuse and localized. Diffuse variety produces diffuse thickening of the bowel wall, affecting short or long segments with oedema and eosinophilic infiltration. History of allergy and eosinophilia are noticeable in diffuse variety.
For the localized variety, Helwig and Ranier[2] coined the term inflammatory fibroid polyp (IFP) which is preferred by pathologists. This is a distinct pathological entity and should be distinguished from other inflammatory polyp of the intestine The characteristic features are polypoidal nature and microscopic appearance with vascular and fibrous elements which are now shown to be of myofibroblastic origin by immuno-histochemical and electron microscopic studies.[5] They are almost always single with variable degree of eosinophilic infiltration.[3]
Etiology of this tumour is controversial It has been postulated that this may be an allergic phenomenon. Yet Ashby et al[1] have shown eosinophilia in only 4% of the collected series. This consideration may suggest local gastro-intestinal reaction to an ingested allergen. As causative agents, Kuipers et al[4] were able to demonstrate the remnants of the larvae of herring parasite Eustoma rotundatum in the bowel of each of 13 patients. He has suggested that repeated exposure to infection may be necessary. Toole and Moschopoulos[6] suggested it to be due to some metabolic disorder similar to Hand-Schuller-Christian diseases and the Letterer-Siwe syndrome.
There is no specific treatment for this condition. Surgical excision is the treatment of choice. Steroids have been tried with success in 2 cases. There is one report of recurrence by Navas-palacios et al.[5] no report of any lesion being or becoming malignant.
We are thankful to the Dean, Seth G. S. Medical College and K. E. M. Hospital to permit us to publish the case.
| 1. | Ashby, B. S., Appleton, P. J. and Dawson, I.: Eosinophilic granuloma of gastrointestinal tract caused by herring parasite Eustoma rotundatum. Brit. Med. J., 1: 1141-1145, 1964.  |
| 2. | Helwig, E. B. and Ranier, A.: Inflammatory fibroid polyps of the stomach. Surg. Gynec. Obstet., 96: 355-367, 1953. |
| 3. | Johnstone, J. M. and Morson, B. C.: Inflammatory fibroid polyp of the gastrointestinal tract. Histopathology, 2: 349-361, 1978. |
| 4. | Kuipels, F. C., Vanthiel, P. H., Rodenburg, W., Wielinga, W. J. and Roskam, R. T.: Eosinophilic phlegmon of the alimentary canal caused by a worm. Lancet, 2: 1171-1173. 1960. |
| 5. | Navas-palacios, J. J., Colino-ruizdelgado, F., Sanchez-larrea, M. D. and Cortescausino, J.: Inflammatory fibroid polyps of the gastro-intestinal tract, an immunohistochemical and electron microscopic study. Cancer, 5t: 1682-1690, 1983. |
| 6. | Toole, H. J. and Moschopoulos, A. N.: Eosinophilic granuloma of the gastrointestinal tract. Brit. J. Surg., 46: 445-448, 1959. |
| 7. | Vaneck, J.: Gastric submucosal granuloma with eosinophilic infiltration. Amer. J. Pathol., 25: 397-411, 1949. |
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