A Case Report of Adhesional Small Bowel Obstruction Caused by Extraintestinal Anisakiasis.

Document Type

Article

Publication Date

12-1-2019

Institution/Department

Emergency Medicine; Medical Education

Journal Title

The Journal of emergency medicine

MeSH Headings

Abdominal Pain, Adult, Animals, Anisakiasis, Anisakis, Digestive System Surgical Procedures, Female, Humans, Intestinal Obstruction, Intestine, Small, Nausea, Seafood, Tomography, X-Ray Computed

Abstract

BACKGROUND: Small bowel obstruction (SBO) is a common diagnosis made in the emergency department (ED). We present a case with an unusual underlying cause of SBO: extraintestinal infection with an Anisakis roundworm.

CASE REPORT: A healthy young woman with no prior abdominal surgery presented with epigastric abdominal pain, nausea, and anorexia 1 day after eating a raw oyster. Laboratory studies were significant for 14% eosinophilia. Initial abdominal computed tomography (CT) showed small bowel inflammation and small-volume ascites. After discharge home, she returned on day 14 of illness with a closed-loop SBO, to which she was predisposed by an adhesion formed in association with an eosinophilic abscess containing an Anisakis roundworm. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Anisakiasis is an uncommon cause of common symptoms with which patients may present to EDs. The diagnosis should be considered in patients presenting with abdominal pain and recent ingestion of raw seafood, with suspicion raised further by the presence of focal gastric or small bowel inflammation and ascites on abdominal CT. Extraintestinal anisakiasis can cause inflammation leading to intraabdominal adhesions, a sequela of which is small bowel obstruction. If suspicion for gastric or intestinal anisakiasis is high, treatment with endoscopic removal or albendazole may be initiated.

ISSN

0736-4679

First Page

175

Last Page

175

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