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    (A) Contrast-enhanced computed tomography scan of the abdomen showing a dilated upper intestine (arrows). (B) A band near the stenosis (arrowheads) and a collapsed intestine (arrows).

  • View in gallery

    A cyclic structure (arrows) constricting the upper small intestine.

  • View in gallery

    A band (arrows) protruded from the jejunum, was 10 cm distal to the ligament of Treitz, and adhered to the mesentery.

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    Histopathologic examination indicated an abscess surrounded by granulation tissue and a degenerated worm (arrows) inside (hematoxylin and eosin stain, ×40).

  • 1.

    Pravettoni V, Primavesi L, Piantanida M, 2012. Anisakis simplex: current knowledge. Eur Ann Allergy Clin Immunol 44: 150156.

  • 2.

    Ishikura H, Kobayashi Y, Miyamoto K, Yagi K, Nakajima O, Fujita O, Oikawa Y, Maejima J, Aji T, Akao Y, Hayasaka H, 1988. Transition of occurrence of anisakiasis and its paratenic host fishes in Japan, with pathogenesis of anisakiasis. Hokkaido Igaku Zasshi 63: 376391.

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Adhesive Intestinal Obstruction Caused by Extragastrointestinal Anisakiasis

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  • Department of Surgery, Suwa Central Hospital, Nagano, Japan

A 44-year-old Japanese woman with no history of laparotomy presented with intermittent abdominal pain that had begun 10 hours earlier. Epigastric tenderness with no muscle guarding was observed. Abdominal contrast-enhanced computed tomography showed a dilated upper small intestine and a band near the stenosis (Figure 1). Internal hernia was diagnosed, and conservative treatment with analgesics was administered. However, abdominal pain persisted. Emergency laparoscopy performed 20 hours after onset revealed two bands. Band A was a cyclic structure constricting the upper small intestine (Figure 2). Band B protruded from the jejunum, was 10 cm distal to the ligament of Treitz, and adhered to the mesentery (Figure 3). Both bands, which were comprised of fibrous tissue, were surgically excised. Band B contained an abscess surrounded by granulation tissue and a degenerated worm inside (Figure 4). Immunostaining revealed the worm to be Anisakis simplex. Thus, extragastrointestinal anisakiasis may have caused adhesive intestinal obstruction. Subsequently, the patient recovered completely.

Figure 1.
Figure 1.

(A) Contrast-enhanced computed tomography scan of the abdomen showing a dilated upper intestine (arrows). (B) A band near the stenosis (arrowheads) and a collapsed intestine (arrows).

Citation: The American Society of Tropical Medicine and Hygiene 92, 4; 10.4269/ajtmh.14-0673

Figure 2.
Figure 2.

A cyclic structure (arrows) constricting the upper small intestine.

Citation: The American Society of Tropical Medicine and Hygiene 92, 4; 10.4269/ajtmh.14-0673

Figure 3.
Figure 3.

A band (arrows) protruded from the jejunum, was 10 cm distal to the ligament of Treitz, and adhered to the mesentery.

Citation: The American Society of Tropical Medicine and Hygiene 92, 4; 10.4269/ajtmh.14-0673

Figure 4.
Figure 4.

Histopathologic examination indicated an abscess surrounded by granulation tissue and a degenerated worm (arrows) inside (hematoxylin and eosin stain, ×40).

Citation: The American Society of Tropical Medicine and Hygiene 92, 4; 10.4269/ajtmh.14-0673

Anisakiasis occurs after eating raw fish or cephalopods contaminated by larvae of the Anisakidae family. Most Anisakis spp. parasitize the gastrointestinal tract, usually the stomach.1 Rarely, anisakiasis occurs ectopically outside the gastrointestinal tract while being asymptomatic and granulomatous.2 Extragastrointestinal anisakiasis should be considered as a possible cause of adhesive intestinal obstruction.

  • 1.

    Pravettoni V, Primavesi L, Piantanida M, 2012. Anisakis simplex: current knowledge. Eur Ann Allergy Clin Immunol 44: 150156.

  • 2.

    Ishikura H, Kobayashi Y, Miyamoto K, Yagi K, Nakajima O, Fujita O, Oikawa Y, Maejima J, Aji T, Akao Y, Hayasaka H, 1988. Transition of occurrence of anisakiasis and its paratenic host fishes in Japan, with pathogenesis of anisakiasis. Hokkaido Igaku Zasshi 63: 376391.

    • Search Google Scholar
    • Export Citation

Author Notes

* Address correspondence to Yasuyuki Takamizawa, Department of Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino-shi, Nagano-ken 391-8503, Japan. E-mail: yasu.mizawa@gmail.com

Authors' addresses: Yasuyuki Takamizawa and Yoshifumi Kobayashi, Department of Surgery, Suwa Central Hospital, Nagano, Japan, E-mails: yasu.mizawa@gmail.com and ykobayashi@suwachuo.jp.

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