Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2012, Article ID 279813, 3 pages doi:10.1155/2012/279813 Case Report Toxic Haemorrhagic Colitis: A Rare Presentation of Eosinophilic Colitis Shen-Ann Eugene Yeo,1 Yon Kuei Lim,1 Kiat Hon Tony Lim,2 and Choong-Leong Tang1 1 Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608 2 Department of Pathology, Singapore General Hospital, Singapore 169608 Correspondence should be addressed to Shen-Ann Eugene Yeo, mrsa 80@yahoo.com.sg Received 4 July 2012; Accepted 21 August 2012 Academic Editors: O. I. Giouleme, I. M. Leitman, and F. H. Mourad Copyright © 2012 Shen-Ann Eugene Yeo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Eosinophilic colitis is a rare condition that usually presents with non speciﬁc abdominal symptoms. Very uncommonly it presents with an acute surgical emergency such as peritonitis or haemorrhage. We present a rare presentation of eosinophilic colitis with toxic hemorrhagic colitis and ischaemic bowel requiring laparotomy and bowel resection. 1. Introduction Eosinophilic colitis (EC) is a rare clinical entity [1]. Its causes may be divided into primary and secondary, with a broad list of diﬀerential diagnoses. The clinical presentation is usually nonspeciﬁc. Severe cases may develop severe abdominal pain and distension, malabsorption, intestinal obstruction, and even gastrointestinal haemorrhage [2]. Once diagnosed, EC responds to steroid therapy. However, due to the nonspeciﬁc nature of the symptoms and the rarity of the condition, it is commonly diagnosed only late in presentation. We discuss a rare case of severe eosinophilic colitis presenting as haemorrhagic colitis requiring laparotomy and bowel resection. 2. Case Presentation A 45-year-old Chinese male presented to the hospital with complaints of a 4-day history of fever, abdominal pain, nausea, and vomiting, as well as mild bloody diarrhea. On examination, he was febrile but otherwise stable. Abdominal examination revealed generalized mild tender- ness, and per-rectal examination revealed slight blood stains and watery stool. His white blood cell count was raised at 16.1 × 10(9)/L. He was treated as for severe gastroenteritis with dehydration with intravenous ﬂuids and antibiotics and subsequently improved clinically. Blood and stool cultures were negative. On the 3rd day of admission, he developed increasing abdominal pain and distension, with a rise in the white cell counts to 17.1 × 10(9)/L. His eosinophil counts also rose to 17.0%. An urgent computed tomogram (CT) of the abdomen and pelvis was ordered which showed a large amount of ascites, as well as a long segment of circum- ferential mural thickening and poor enhancement of the ascending colon and proximal transverse colon suggesting ischaemic bowel (Figures 1, 2, and 3). An emergency laparotomy was performed. Intraopera- tively, there was 2 litres of hemoperitoneum from severe haemorrhagic colitis and transmural infarction involving the right and proximal transverse colon. An extended right hemicolectomy and double-barreled stoma were performed. Histology revealed ischaemic bowel with eosinophilic inﬂammation and vasculitis involving the mesenteric vessels (Figure 4), with patchy transmural haemorrhagic infarction and eosinophilic microabscesses present. Nine lymph nodes showed eosinophilic inﬁltration. The overall picture is consistent with that of eosinophilic vasculitis and colitis. 3. Discussion Haemorrhagic colitis has many diﬀerent etiologies, including infectious colitis with either bacterial or parasitic infections.