Eosinophilic Gastroenteritis Mimicking Pyloric Stenosis in Infants: Medical Management over Hasty Surgery

Background Eosinophilic gastrointestinal disorders (EGID) are rare disorders characterized by eosinophilic infiltration of gastrointestinal tract; eosinophilic gastroenteritis (EG) is a specific category of EGID referring to eosinophilic infiltration of the stomach and/or small intestine (1). EG affects both children and adults, and has a highly variable presentation (2). A US population-based study estimated the prevalence of EG/EoD at about 15 per 100,000 people, but recent research suggests it is likely underdiagnosed (4). While there is currently no standard for the diagnosis of EGID, presence of eosinophilic infiltrate on biopsy with greater than 10 eosinophils per high power field (hpf), associated Gastrointestinal (GI) symptoms, and exclusion of other causes of eosinophilia are generally accepted to diagnose EGID in children (1, 2). EG can be commonly misdiagnosed as infantile hypertrophic pyloric stenosis (IHPS) when infants present with projectile vomiting, and duodenal structuring (3). EG can be classified into three forms based on the predominance of eosinophilic infiltration: mucosal, muscular, and subserosal (3). The muscular form, which causes thickening of the bowel wall, can lead to obstructive GI symptoms and is often confused with IHPS given similarity of clinical presentation (1, 3). This can be detrimental given that treatment of EGID is medical while that of pyloric stenosis is surgical. Index of suspicion and standardized diagnosis of EGID is necessary to avoid unnecessary surgeries. The following two cases which we present exemplify this further and demonstrate the importance of appropriate diagnosis and pursuing medical management while avoiding hasty surgical intervention.