Hiroki Fujikawa, Toshio Kuwai, Toshiki Yamaguchi, Ryoichi Miura, Yuki Sumida, Takeshi Takasago, Yuki Miyasako, Tomoyuki Nishimura, Sumio Iio, Hiroki Imagawa, Atsushi Yamaguchi, Hirotaka Kouno, Hiroshi Kohno, Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
Author contributions: Kuwai T assessed the patients; Fujikawa H and Yamaguchi T wrote the manuscript; Nishimura T and Iio S assisted in performing the diagnostic tests; Miura R, Sumida Y, Takasago T, and Miyasako Y interpreted the data; Imagawa H, Yamaguchi A, Kouno H, and Kohno H critically reviewed the manuscript.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: None.
Correspondence to: Toshio Kuwai, MD, PhD, Chief Doctor, Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan. kuwait@kure-nh.go.jp
Telephone: +81-823-223111 Fax: +81-823-210478
Received: July 14, 2017 Peer-review started: July 16, 2017 First decision: January 15, 2018 Revised: January 20, 2018 Accepted: March 1, 2018 Article in press: March 1, 2018 Published online: March 16, 2018 Processing time: 63 Days and 22.8 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A 59-year-old Japanese woman who had eaten sliced raw horse mackerel and salmon at lunch presented with epigastric pain and vomiting since the evening.
Clinical diagnosis
Tenderness in the epigastrium without obvious rebound tenderness or guarding.
Differential diagnosis
Acute abdomen including digestive disorders and gynecological disorders, acute coronary syndromes, urinary system diseases.
Laboratory diagnosis
All labs were within normal limits, except for increased C-reactive protein (19.7 mg/dL).
Imaging diagnosis
Computed tomography (CT) scan demonstrated segmental edema of the intestinal wall with dilated bowel and a small number of ascites, and endoscopy revealed that nine Anisakis larvae were attached to the gastric mucosa.
Treatment
Direct endoscopic removal of all of the Anisakis larvae in the stomach with a biopsy forceps and Gastrografin administration for enteric anisakiasis.
Experiences and lessons
Abdominal CT is useful for the diagnosis of enteric anisakiasis and Gastrografin administration therapy is useful for the extraction of enteric Anisakis larvae.
