Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report
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 is...
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Japan Surgical Society
2020-10-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-01033-2 |
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| author | Kengo Shibata Yuichi Yoshida Yoichi Miyaoka Shin Emoto Tomoaki Kawai Seiji Kobayashi Kazuhiro Ogasawara Akinobu Taketomi |
| author_facet | Kengo Shibata Yuichi Yoshida Yoichi Miyaoka Shin Emoto Tomoaki Kawai Seiji Kobayashi Kazuhiro Ogasawara Akinobu Taketomi |
| author_sort | Kengo Shibata |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-01f4c1f75e674933b1a88cd15122f85f |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-01f4c1f75e674933b1a88cd15122f85f2025-08-20T03:30:52ZengJapan Surgical SocietySurgical Case Reports2198-77932020-10-01611510.1186/s40792-020-01033-2Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case reportKengo Shibata0Yuichi Yoshida1Yoichi Miyaoka2Shin Emoto3Tomoaki Kawai4Seiji Kobayashi5Kazuhiro Ogasawara6Akinobu Taketomi7Division of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDivision of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDivision of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDivision of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDivision of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDivision of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDivision of Surgery, Japan Organization of Occupational Health and Safety, Kushiro Rosai HospitalDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s40792-020-01033-2Live larvaExtraluminalIntestinal resectionAnisakiasisLaparoscopic exploration |
| spellingShingle | Kengo Shibata Yuichi Yoshida Yoichi Miyaoka Shin Emoto Tomoaki Kawai Seiji Kobayashi Kazuhiro Ogasawara Akinobu Taketomi Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report Surgical Case Reports Live larva Extraluminal Intestinal resection Anisakiasis Laparoscopic exploration |
| title | Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report |
| title_full | Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report |
| title_fullStr | Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report |
| title_full_unstemmed | Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report |
| title_short | Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report |
| title_sort | intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae a case report |
| topic | Live larva Extraluminal Intestinal resection Anisakiasis Laparoscopic exploration |
| url | http://link.springer.com/article/10.1186/s40792-020-01033-2 |
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