Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis

Dong Baek Kang; Jung Taek Oh; Won Cheol Park; Jeong Kyun Lee

doi:10.4166/kjg.2010.56.3.192

Journal List > Korean J Gastroenterol > v.56(3) > 1006711

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Kang, Oh, Park, and Lee: Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis

Original Article

Korean J Gastroenterol 2010;56(3):192-195.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.3.192

Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis

Dong Baek Kang, M.D., Jung Taek Oh, M.D., Won Cheol Park, M.D., Jeong Kyun Lee, M.D.

Department of Surgery and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea

Correspondence to: Dong Baek Kang, M.D. Department of Surgery, Wonkwang-Gunsan Medical Center, 29-1, Jigok-dong, Gunsan 573-713, Korea Tel: +82-63-472-5070, Fax: +82-63-855-2386 E-mail: east1st@wku.ac.kr

Received 14 December 2009 Accepted 16 March 2010

Abstract

Anisakiasis usually occurs in the stomach and can easily be diagnosed by digestive tract endoscopy as opposed to enteric anisakiasis which is very rare and difficult to be diagnosed definitively. The most important and useful tool in diagnosing enteric anisakiasis is obtaining an accurate patient history of having eaten raw fish before the onset of symptoms. We report a case of small bowel obstruction caused by acute invasive enteric anisakiasis. A 60-year-old woman visited the emergency room suffering from sudden abdominal pain. She had eaten raw fish 1 day before the onset of symptom. Radiologic studies showed small bowel obstruction. However, no definitive cause could be found. An emergency laparotomy revealed edematous and dilated proximal jejunum and a focal stenosis of the distal jejunum. Segmental resection of the jejunum was performed, and histopathological examination revealed enteric anisakiasis. The patient was discharged on the 7th day after surgery following an uneventful course of recovery.

Keywords: Anisakiasis, Intestinal obstruction

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Fig. 1.

Plain abdominal radiography showed dilatation of the small bowel.

Fig. 2.

Abdominopelvic CT showed dilated small bowel loops filled with fluid and target shaped wall thickening of the jejunum (arrow) with luminal narrowing.

Fig. 3.

Operative finding showed focal stenosis of the distal jejunum and inflammatory change around the stenotic lesion.

Fig. 4.

Histopathologic findings showed the severe infiltration of inflammation and edema in all layers of the intestinal wall with a submucosal eosinophilic granuloma around larvae (arrows), which were findings of anisakiasis (A) (H&E ×40), and magnification view of square showed eosinophilic granuloma around anisakiasis larva (B) (H&E ×200).

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