A Case Report of Adhesional Small Bowel Obstruction Caused by Extraintestinal Anisakiasis

Small bowel obstruction (SBO) is a common diagnosis made in the emergency department (ED). We present a case with an unusual underlying cause of SBO: extraintestinal infection with an Anisakis roundworm. A healthy young woman with no prior abdominal surgery presented with epigastric abdominal pain,...

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Bibliographic Details
Published in:The Journal of emergency medicine 2019-12, Vol.57 (6), p.e175-e179
Main Authors: Allison, Christopher, Baumann, Michael
Format: Article
Language:English
Subjects:
anisakiasis
bowel obstruction
food-borne illness
gastroenterology
helminth
infectious disease
parasitology
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Summary:Small bowel obstruction (SBO) is a common diagnosis made in the emergency department (ED). We present a case with an unusual underlying cause of SBO: extraintestinal infection with an Anisakis roundworm. A healthy young woman with no prior abdominal surgery presented with epigastric abdominal pain, nausea, and anorexia 1 day after eating a raw oyster. Laboratory studies were significant for 14% eosinophilia. Initial abdominal computed tomography (CT) showed small bowel inflammation and small-volume ascites. After discharge home, she returned on day 14 of illness with a closed-loop SBO, to which she was predisposed by an adhesion formed in association with an eosinophilic abscess containing an Anisakis roundworm. Anisakiasis is an uncommon cause of common symptoms with which patients may present to EDs. The diagnosis should be considered in patients presenting with abdominal pain and recent ingestion of raw seafood, with suspicion raised further by the presence of focal gastric or small bowel inflammation and ascites on abdominal CT. Extraintestinal anisakiasis can cause inflammation leading to intraabdominal adhesions, a sequela of which is small bowel obstruction. If suspicion for gastric or intestinal anisakiasis is high, treatment with endoscopic removal or albendazole may be initiated.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2019.08.038