J Korean Soc Radiol.  2011 Feb;64(2):167-171. 10.3348/jksr.2011.64.2.167.

CT Findings of Small Bowel Anisakiasis: Analysis of Four Cases

• Kim WK
• Song SY
• Cho OK
• Koh BH
• Kim Y
• Jung WK
• Kim MY

• KMID: 2097933
• DOI: http://doi.org/10.3348/jksr.2011.64.2.167

Abstract

PURPOSE
We wanted to describe the CT findings of small bowel anisakiasis with the pathologic correlation.
MATERIALS AND METHODS
Four patients with surgically and pathologically proven small bowel anisakiasis were included in this retrospective study. They were three men and one woman and their ages ranged from 28 to 43 years (mean age: 38 years). We evaluated their clinical, CT and histological findings.
RESULTS
All the patients had a history of ingesting raw fish within 24 hours from the time of symptom onset. They complained of abdominal pain (n=4), nausea (n=4), vomiting (n=2) and diarrhea (n=1). Physical examination revealed tenderness (n=4), rebound tenderness (n=4) and increased bowel sounds (n=3). Leukocytosis was noted in all the patients on the laboratory examination. None of the patients showed eosinophilia. The CT findings were segmental small bowel wall thickening with preserved layering (n=4), focal segmental luminal narrowing with proximal dilatation (n=4), peritoneal thickening (n=3), mesenteric or omental infiltration (n=4) and varying degrees of ascites (n=4). On the histopathologic examination, they revealed an infiltration of eosinophils (n=4) in all layers of the bowel wall with severe edema. The larvae were found on surgico-pathologic examination in all the cases.
CONCLUSION
The CT findings may be helpful to make the specific diagnosis of small bowel anisakiasis in a patient with the clinical findings of an acute abdomen and a history of eating raw fish.

MeSH Terms

Abdomen, Acute
Abdominal Pain
Anisakiasis
Ascites
Diarrhea
Dilatation
Eating
Edema
Eosinophilia
Eosinophils
Female
Humans
Larva
Leukocytosis
Male
Nausea
Phenobarbital
Physical Examination
Retrospective Studies
Tomography, X-Ray Computed
Vomiting
Phenobarbital

Figure

• 

  Fig. 1. A 43-year-old male patient with small bowel anisakiasis (Case 2). The CT findings (A and B): The axial scan of abdominal CT at the level of the iliac crest (A) shows circumferential wall thickening or edema of a long segment of the jejunum with peritoneal thickening and mesenteric infiltration. Proximal luminal dilatation from the transition zone is also noted (arrow). There is ascites at the right gutter. The axial scan at the level of the kidney (B) shows dilated proximal bowel loops that mimic obstructive ileus (arrows). The pathologic features (C and D): Photomicroscopy (C) show a helminthic larva (arrows) penetrating the bowel mucosa (H & E, ×40). There is a dense infiltration of eosinophils with other inflammatory cells in all the layers of the small bowel (H & E, ×20) (D).

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