A 39-year-old man visited my clinic because of persisitent epigastric pain. He ate raw fish“shime saba”4 days ago, and had epigastralgia since next morning. Physical examination was non-remarkable except for tenderness on epigastric region. Ultrasonography showed gall bladder debris. Endoscopic examination of upper GI tract revealed dome-shaped mucosal nodule with erosions and Anisakis penetrating the mucosa of the duodenal bulb. A warm was successfully removed with using biopsy forceps. Epigastric pain disappeared soon thereafter.
Anisakiasis is common parasitic infection of GI tract, but rarely found in duodenum (0.64%) . To my knowledge, this is the fifth case of duodenal anisakiasis reported in Japan.
