HISTORY

A 32-year old American housewife was admitted to the hospital complaining of abdominal pain, fever, and diarrhea for 4 days. She had suffered from nonradiating abdominal pain for two years, which she attributed to her menstrual cycle, but it had recently gotten much worse. She often ate raw herring and salted salmon and had sampled pieces of raw fish during salting 3 months prior to admission as a patient. Four days prior, she had experienced cramping, increasing abdominal pain, and fever and diarrhea.

 

EXAMINATION

BP 125/90, P 100, R 20, T 99.6°F. A well-developed woman in no acute distress complaining of pain in right lower abdominal quadrant. Normal bowel sounds, no abdominal rigidity, but there was tenderness and a palpable mass in the right lower abdominal quadrant. Pelvic and rectal exam were normal except that the right ovary was not palpable.

 

LABORATORY

Hemoglobin - 12.1 gm‰

WBC - 19,000

Chest X-ray - Normal

Plain films of the abdomen suggested a right lower quadrant abdominal mass.

GI series showed the terminal ileum, cecum, and ascending colon to be narrowed, fixed, and distorted, but not obstructed. The ileoceccal valve appeared thickened.

 

CLINICAL COURSE

After being admitted, her temperature rose to 101°F. On the 2nd day, she underwent laparatomy, which suggested either a malignant tumor or an inflammatory mass. A right colectomy and ileocolostomy were performed, and pathological findings revealed an eosinophilic granuloma with an Anisakis larva in pericecal fat. Recovery was uneventful. Six months later, she felt better than at any previous time. She has since abandoned the practice of eating raw fish.

 

 

Case Study #2: "A case of extragastrointestinal anisakiasis involving a mesocolic lymph node." (1997) Kim HJ, Park C. Korean J Parasitol. Mar; 35 (1): p. 63-66.

A 43-year-old man in Seoul, Korea, presented with a malignant stromal tumor, for which he underwent radical gastrectomy. He was found to have an enlarged lymph node at the transverse mesocolon, which exhibited necrotizing eosinophilic granuloma around pieces of nematode larvae. The larvae possessed Y-shaped lateral cords, large excretory gland cells, intestine, and eosinophilic cuticle. When combined with the patient's dietary history, the nematodes were identified as Anisakis simplex. This man was Korea's first case of extragastrointestinal anisakiasis.

 

 

Case Study #3: "Gastric anisakiasis diagnosed by endoscopy." (1997) Romeo Ramirez et al. Gastroenterol Hepatol. Jun-Jul; 20 (6): p. 306-308.

A 75-year old male in Vitoria, Spain, presented typical anisakiasis symptoms, which were in turn supported by the patient's recent history of ingesting undercooked microwaved fish and a positive serologic study for the IgE specific for Anisakis simplex. The final confirmation was received by the use of endoscopy to positively confirm the presence of the larvae.

 

Case Study #4: "Intestinal anisakiasis requiring surgical treatment in an emergency setting". Moschella C.M., Mattiucci S., Borromeo C., Fazzini D., Ruggiero M.I., De Angelis G. Emergency Department (DEA 2) University Hospital "Azienda Policlinico Umberto I" University "La Sapienza" Rome - Italy

"A 37-year old woman was admitted in an emergency setting to our Emergency Department (ED) with a diagnosis of acute appendicitis. Physical exam showed tenderness in the right lower abdomen. The plain abdomen X-ray demonstrated the presence of several levels in the small intestine and sonography detected distension of the right colon and presence of ascites. According to the diagnosis of appendicitis we performed a McBurney incision. The surgical exploration revealed a large mass in the caecum region and therefore a mid-line laparotomy was performed. Right colectomy with ileo-transverse T-T anastomosis was performed. The postoperative course was uneventful and the patient was discharged after ten days. Pathology revealed the presence of several eosinophilic granuloma due to Anisakis larva."

(Taken from http://www-cdu.dc.med.unipi.it/eates4/Abstracts/Miscellanea/241.htm)

 

Case Study #5: "Eosinophilic gastritis due to Anisakis: a case report". (2000) Esteve C, Resano A. Allergol Immunopathol, Jan-Feb; 28 (1): p. 21-23.

A 14-year-old boy in Pamplona, Spain, presented with a diagnosed case of eosinophilic gastritis after an endoscopy and biopsy after recurrent abdominal pain. He also exhibited a type I hypersensitivity mechanism against Anisakis simplex, which was concluded by a prick test, antigen specific IgE determination, and an antigen specific histamine release test. The patient subsequently eliminated seafood from his diet, and has been asymptomatic for two years.