A Surgical Case of Small Intestinal Anisakiasis with Intestinal Obstruction Due to Food

Abstract

A 71-year-old woman visited our emergency department with abdominal pain and vomiting starting the night of December 25, 2010. On arrival, her abdomen was distended and peritoneal irritation was present. Plain abdominal x-ray showed air-fluid levels. Computed tomography of the abdomen revealed wall thickening of the small intestine, dilatation of the proximal small intestine, and moderate-volume ascites. An emergency laparotomy was performed under a diagnosis of ileus. Serous ascites was found in the peritoneal cavity. The small intestine was greatly dilated with wall thickening at three portions between 306cm and 404cm distal from the ligament of Treiz. Food residues were incarcerated in one of these portions, suggesting dietary ileus. The small intestine (approximately 1m) was partially resected. Postoperatively, the patient was found to have eaten raw squid before this episode. Serum testing for anti-Anisakis IgG and IgA antibody titer was positive and parasitic bodies of Anisakis were confirmed histopathologically. Her postoperative course was uneventful and she was discharged 14 days after the operation. Small intestinal anisakiasis is relatively rare and difficult to diagnose definitively. When a patient presents with acute abdomen accompanied by ileus, small intestinal anisakiasis should be included among the differential diagnoses and surgery should be considered.