2009 Volume 29 Issue 6 Pages 925-929
A 31-year-old man who developed sudden lower abdominal pain and vomiting was referred to our hospital's emergency room by a local physician due to increased abdominal pain on the day after onset. Tenderness and muscular guarding centered in the lower abdomen were observed in the initial examination, and abdominal contrast CT showed ascites retention, a dilated small intestine in the lower abdomen, and mesenteric convergence. Strangulated ileus was diagnosed 18 hours after onset and emergency surgery was performed. Upon laparotomy, 500mL of hemorrhagic ascites was found in the abdominal cavity and about 80cm of the ileum was strangulated by a band about 2cm in length from 10cm orally from the antimesenteric side of the ileum toward the mesentery of the small intestine. Surgical excision of the band and partial resection of the ileum were performed. The band was a granuloma with infiltration of multinucleated white blood cells, and a necrotized worm was found inside. The worm was identified as Anisakis simplex, sensu stricto, with the polymerase chain reaction (PCR) method, and the final diagnosis was strangulated ileus by extra-gastrointestinal anisakiasis. This case shows that an extra-gastrointestinal anisakiasis should be kept in mind as a possible cause of strangulated ileus in a patient with no history of laparotomy.
