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Shibata K, Yoshida Y, Miyaoka Y, Emoto S, Kawai T, Kobayashi S, Ogasawara K, Taketomi A. Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report. Surg Case Rep 2020; 6:253. [PMID: 33001287 PMCID: PMC7530153 DOI: 10.1186/s40792-020-01033-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/23/2020] [Indexed: 12/04/2022] Open
Abstract
Background Anisakiasis is a parasitic infection caused by Anisakis worms found in raw fish. Most cases of anisakiasis occur in the stomach and rarely occur in the intestine. It is extremely rare for live larvae to break through the intestine into the mesentery and cause severe intestinal ischemia. Anisakiasis can be treated conservatively, because the larvae will die in approximately 1 week, but, sometimes, a serious condition can arise, as in this case. We report the first case of extraluminal anisakiasis in which a live Anisakis worm caused severe intestinal ischemia. Case presentation The patient was a 26-year-old woman who ate squid a week prior. She had abdominal pain and was admitted to our emergency department. On physical examination, abdominal guarding and rebound tenderness were present in her lower abdomen. Contrast-enhanced computed tomography showed ascites, the whirl sign, localized submucosal edema of the intestinal wall, and a dilated small bowel segment with edema. We suspected the strangulated small bowel obstruction based on the CT-scan findings. To rule out the strangulated small bowel obstruction, laparoscopic exploration was performed. Bloody ascites in the pouch of Douglas and severe inflammation in 20 cm of the ileum were observed. An Anisakis larva had perforated the intestinal wall and was found alive in the mesentery. The ileum had developed a high degree of ischemia, so the affected section was resected. Histopathological examination revealed that the Anisakis worm body was in the inflamed mesentery and caused a high degree of ischemia in the intestinal tract. The patient was discharged 9 days after surgery. Conclusions A living Anisakis larva punctured the mesentery of the small intestine, resulting in severe intestinal ischemia. As seen in this case, intestinal anisakiasis may cause serious symptoms, and a low threshold for performing diagnostic laparoscopy for the early diagnosis of bowel ischemia secondary to anisakiasis can be useful in determining the definite diagnosis and indications for resection.
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Affiliation(s)
- Kengo Shibata
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan. .,Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yuichi Yoshida
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan
| | - Yoichi Miyaoka
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan
| | - Shin Emoto
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan
| | - Tomoaki Kawai
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan
| | - Seiji Kobayashi
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan
| | - Kazuhiro Ogasawara
- Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro City, Hokkaido, 085-8533, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Kawashima K, Fujiwara T, Katakura K, Gunji N, Yokokawa A, Sakamoto A, Hikichi T, Kono K, Ohira H. Anisakiasis in the Small Intestine with Excessive Bleeding That Was Difficult to Diagnose Endoscopically. Intern Med 2019; 58:63-66. [PMID: 30146603 PMCID: PMC6367072 DOI: 10.2169/internalmedicine.1482-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Anisakiasis involves the stomach in most cases and occurs rarely in the small intestine. Anisakiasis in the small intestine is associated with abdominal pain and obstruction and is rarely associated with intestinal bleeding. Unlike in the stomach, anisakiasis in the small intestine is difficult to diagnose anatomically. The patient in this case study developed hypovolemic shock due to excessive bleeding and underwent emergency surgery. With the recent increase in the consumption of raw fish around the world, this report provides an important finding of bleeding in the small intestine due to an unknown cause.
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Affiliation(s)
- Kazumasa Kawashima
- Department of Gastroenterology, Fukushima Medical University School Medicine, Japan
| | - Tatsuo Fujiwara
- Department of Gastroenterology, Fukushima Medical University School Medicine, Japan
| | - Kyoko Katakura
- Department of Gastroenterology, Fukushima Medical University School Medicine, Japan
| | - Naohiko Gunji
- Department of Gastroenterology, Fukushima Medical University School Medicine, Japan
| | - Aki Yokokawa
- Department of Gastroenterology, Fukushima Medical University School Medicine, Japan
| | - Ayumu Sakamoto
- Department of Gastrointestinal Surgery, Fukushima Medical University School Medicine, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Japan
| | - Koji Kono
- Department of Gastrointestinal Surgery, Fukushima Medical University School Medicine, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School Medicine, Japan
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Common Symptoms from an Uncommon Infection: Gastrointestinal Anisakiasis. Can J Gastroenterol Hepatol 2016; 2016:5176502. [PMID: 27800471 PMCID: PMC5075291 DOI: 10.1155/2016/5176502] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/22/2016] [Indexed: 11/30/2022] Open
Abstract
Clinicians can be forgiven for thinking of anisakiasis as a rare condition low in the differential diagnosis of abdominal pain. Gastrointestinal anisakiasis is a zoonotic parasitic disease caused by consumption of raw or undercooked seafood infected with nematodes of the genus Anisakis. Even though the reported cases indicate that this is a rare disease, the true incidence of the disease could be potentially higher than what is reported in the literature as cases can go undiagnosed. Diagnosis and treatment of gastric anisakiasis are made by a compatible dietary history, direct visualization, and removal of the larvae via gastroscopy. Serologic testing and imaging studies are useful in the diagnosis of intestinal anisakiasis and conservative management should be considered. This disease may mimic other diseases and lead to unnecessary surgery. This emphasizes the importance of suspecting gastrointestinal anisakiasis by history taking and by other diagnostic modalities.
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Shrestha S, Kisino A, Watanabe M, Itsukaichi H, Hamasuna K, Ohno G, Tsugu A. Intestinal anisakiasis treated successfully with conservative therapy: Importance of clinical diagnosis. World J Gastroenterol 2014; 20:598-602. [PMID: 24574731 PMCID: PMC3923037 DOI: 10.3748/wjg.v20.i2.598] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/05/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
Intestinal anisakiasis is not only a rare parasitic disease, but is also difficult to diagnose. The symptoms are not specific and are often very severe and abrupt, and the findings of clinical imaging are very remarkable. Therefore, intestinal anisakiasis is often misdiagnosed as acute abdomen or intestinal obstruction and is treated surgically. However, if intestinal anisakiasis could be diagnosed correctly, it is well treated conservatively. We experienced three cases of intestinal anisakiasis, which were diagnosed correctly and treated successfully with conservative therapy. A correct clinical history and imaging interpretation helped us diagnose intestinal anisakiasis correctly and thus treat the patients successfully with conservative therapy.
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Kim T, Song HJ, Jeong SU, Choi EK, Cho YK, Kim HU, Song BC, Kim KS, Kim BS, Kim YR. Comparison of the clinical characteristics of patients with small bowel and gastric anisakiasis in jeju island. Gut Liver 2012; 7:23-9. [PMID: 23423474 PMCID: PMC3572316 DOI: 10.5009/gnl.2013.7.1.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 03/28/2012] [Accepted: 04/07/2012] [Indexed: 11/30/2022] Open
Abstract
Background/Aims Anisakiasis is frequent in Jeju Island because of the people's habit of ingesting raw fish. This study evaluated the clinical characteristics of patients with small bowel anisakiasis and compared them with those of patients with gastric anisakiasis. Methods We retrospectively reviewed the medical records of 109 patients diagnosed with anisakiasis between May 2003 and November 2011. Results Of the 109 patients diagnosed with anisakiasis, those with suspicious anisakiasis (n=38) or possible anisakiasis (n=12) were excluded. The age and gender distributions did not differ between patients with small bowel anisakiasis (n=30; age, 45±13 years) and those with gastric anisakiasis (n=29; age, 46±10 years). The mean duration of hospitalization was 5.4±4.3 days for patients with small bowel anisakiasis and 0.5±1.7 days for patients with gastric anisakiasis. Small bowel anisakiasis was accompanied by leukocytosis (76.7% vs 25.5%, p=0.003) and elevated C-reactive protein levels (3.4±3.2 mg/dL vs 0.5±0.3 mg/dL, p=0.009). Contrast-enhanced abdominopelvic computed tomography showed small bowel wall thickening with dilatation in 93.3% (28/30) of patients and a small amount of ascites in 80.0% (24/30) of patients with small bowel anisakiasis. Conclusions Compared with gastric anisakiasis patients, small bowel anisakiasis patients had a longer hospitalization time, higher inflammatory marker levels, and small bowel wall thickening with ascites.
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Affiliation(s)
- Taeyun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Kang DB, Oh JT, Park WC, Lee JK. Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 56:192-5. [DOI: 10.4166/kjg.2010.56.3.192] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dong Baek Kang
- Department of Surgery and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Jung Taek Oh
- Department of Surgery and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Jeong Kyun Lee
- Department of Surgery and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
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Kawabata H, Kimura Y, Kisa K, Murakami M, Maezawa M. Acute Intestinal Obstruction Due to Intestinal Anisakiasis Resolved with Conservative Therapy. J Rural Med 2009. [DOI: 10.2185/jrm.4.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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