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• W2065395712 abstract "Question: A 39-year-old Japanese man was brought to the hospital with epigastric pain and vomiting that had begun 1 day before the visit. He was conscious, his blood pressure was 126/78 mmHg, pulse 72 beats/min, and body temperature 37.6°C. The abdomen was inflated and tympanic. The tenderness was confined to the periumbilical area of the abdomen. Rebound tenderness was noted, but the abdominal defense reflex was absent. The bowel sounds were silent and there was no flatus. He had no history of a laparotomy and was taking no medications. Laboratory values obtained on admission were: white blood cell count, 9990/mm3 (normal range, 3500–9000); and C-reactive, protein, 7.53 mg/dL (normal range, <0.3). The number of peripheral blood eosinophils was 2.5% (normal range, <7%) and other laboratory tests showed no abnormalities. Plain radiography of the abdomen showed loops of the small intestine and an air–fluid level (FigureA) . Abdominal computed tomography (CT) showed a dilated small intestine, ascites, and wall thickening of the part of small intestine, but the cause of the obstruction was unclear (FigureB). What is the most likely diagnosis for this patient? Look on pagepage 1797for the answer and see the Gastroenterologyweb site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. An emergency laparotomy was performed. There was a small amount of pale yellow ascites and a focal inflammatory change in the small intestine, which was suspected to be associated with stenosis, located about 120 cm from the Treitz ligament (FigureC). Partial resection of the small intestine was performed. On examination of the excised small intestine, the complete body of a live anisakis was found, thrusting its head into the intestinal mucosa (FigureD). Histopathologic examination revealed infiltration of eosinophils in all layers of the intestinal wall and marked edema (FigureE). He had eaten sliced raw fish (sashimi) 2 days before admission to the hospital. The patient had an uneventful postoperative course. Anisakiasis is a relatively common disease in areas of the world where people regularly eat raw fish, such as Japan, northern or southern Europe, and the Pacific coast of South America.1Caramello P. Vitali A. Canta F. et al.Intestinal localization of anisakiasis manifested as acute abdomen.Clin Microbiol Infect. 2003; 9: 734-737Crossref PubMed Scopus (55) Google Scholar However, preoperative diagnosis is difficult without obtaining an accurate history of the present illness and determining whether the patient has eaten raw fish before the onset of symptoms. Gastrointestinal anisakiasis is caused by the ingestion of Anisakis spp. larvae in raw fish such as mackerel, horse mackerel, cuttlefish, and sardines.1Caramello P. Vitali A. Canta F. et al.Intestinal localization of anisakiasis manifested as acute abdomen.Clin Microbiol Infect. 2003; 9: 734-737Crossref PubMed Scopus (55) Google Scholar Most cases of anisakiasis occur in the stomach and several successful endoscopic treatments have been reported. Gastric anisakiasis usually develops several hours after the ingestion of raw fish, whereas the onset of small bowel anisakiasis is delayed from 1 to 5 days. Small bowel anisakiasis is rare and shows ileus-like symptoms. The dilation and wall thickening of the small intestine and accumulation of ascites detected by CT scans are useful in making a differential diagnosis.2Takabe K. Ohki S. Kunihiro O. et al.Anisakidosis: a cause of intestinal obstruction from eating sushi.Am J Gastroenterol. 1998; 93: 1172-1173Crossref PubMed Scopus (46) Google Scholar, 3Sasaki T. Fukumori D. Matsumoto H. et al.Small bowel obstruction caused by anisakiasis of the small intestine: report of a case.Surg Today. 2003; 33: 123-125Crossref PubMed Scopus (24) Google Scholar A definitive diagnosis of small bowel anisakiasis is generally achieved after laparotomy. Small bowel anisakiasis should therefore be considered when patients present with acute abdominal pain and intestinal dilation on CT scans after the ingestion of raw fish, such as sushi or sashimi." @default.
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• W2065395712 date "2010-11-01" @default.
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• W2065395712 title "Acute Abdomen With Epigastric Pain and Vomiting in an Adult Healthy Patient" @default.
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• W2065395712 doi "https://doi.org/10.1053/j.gastro.2009.11.060" @default.
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