A Case of Bowel Obstruction Caused by Small Bowel Anisakiasis that was Successfully Treated Using Hyperbaric Oxygen Therapy

Abstract

A 55-year-old man was admitted to the hospital because of abdominal pain and vomiting after he had eaten sliced raw fish 3 days previously. A sharp tenderness and distension was present in the middle abdomen, but the presence of peritoneal irritation was unclear. A plain abdominal X-ray showed signs of ileus. A computed tomography (CT) examination of the abdomen revealed partial wall thickening and stenosis of the small intestine with wall enhancement, dilatation of the proximal small intestine, and the accumulation of ascites. On the same day, he underwent hyperbaric oxygen therapy (HBOT) with a primary diagnosis of small bowel anisakiasis and bowel obstruction. On the day after HBOT, his abdomen was no longer distended and the abdominal tenderness had disappeared. An abdominal X-ray examination showed no signs of ileus, such as air-fluid levels. An abdominal CT examination demonstrated an improvement in wall thickening and stenosis of the small intestine and the disappearance of ascites. His post-HBOT course was favorable, and he was discharged 8 days after HBOT without requiring a surgical operation. We confirmed the diagnosis based on an elevated serum anti-anisakiasis-specific IgE antibody level. Anisakiasis of the small intestine is relatively rare; however, we should keep in mind that anisakiasis can develop into bowel obstruction. Though anisakiasis can generally be treated conservatively, HBOT is an extremely useful treatment for small bowel anisakiasis that has developed into bowel obstruction.