A 32-year old American housewife was
admitted to the hospital complaining of abdominal pain, fever, and
diarrhea for 4 days. She had suffered from nonradiating abdominal
pain for two years, which she attributed to her menstrual cycle, but
it had recently gotten much worse. She often ate raw herring and salted
salmon and had sampled pieces of raw fish during salting 3 months
prior to admission as a patient. Four days prior, she had experienced
cramping, increasing abdominal pain, and fever and diarrhea.
BP 125/90, P 100, R 20, T 99.6°F. A well-developed
woman in no acute distress complaining of pain in right lower abdominal
quadrant. Normal bowel sounds, no abdominal rigidity, but there
was tenderness and a palpable mass in the right lower abdominal
quadrant. Pelvic and rectal exam were normal except that the right
ovary was not palpable.
Hemoglobin - 12.1 gm
WBC - 19,000
Chest X-ray - Normal
Plain films of the abdomen suggested a right lower
quadrant abdominal mass.
GI series showed the terminal ileum, cecum, and
ascending colon to be narrowed, fixed, and distorted, but not obstructed.
The ileoceccal valve appeared thickened.
After being admitted, her temperature rose to 101°F.
On the 2nd day, she underwent laparatomy, which suggested either
a malignant tumor or an inflammatory mass. A right colectomy and
ileocolostomy were performed, and pathological findings revealed
an eosinophilic granuloma with an Anisakis larva in pericecal
fat. Recovery was uneventful. Six months later, she felt better
than at any previous time. She has since abandoned the practice
of eating raw fish.
Case Study #2: "A case of
extragastrointestinal anisakiasis involving a mesocolic lymph node."
(1997) Kim HJ, Park C. Korean J Parasitol. Mar; 35 (1): p.
A 43-year-old man in Seoul, Korea, presented with
a malignant stromal tumor, for which he underwent radical gastrectomy.
He was found to have an enlarged lymph node at the transverse mesocolon,
which exhibited necrotizing eosinophilic granuloma around pieces of
nematode larvae. The larvae possessed Y-shaped lateral cords, large
excretory gland cells, intestine, and eosinophilic cuticle. When combined
with the patient's dietary history, the nematodes were identified
as Anisakis simplex. This man was Korea's first case of extragastrointestinal
Case Study #3: "Gastric anisakiasis
diagnosed by endoscopy." (1997) Romeo Ramirez et al. Gastroenterol
Hepatol. Jun-Jul; 20 (6): p. 306-308.
A 75-year old male in Vitoria, Spain,
presented typical anisakiasis symptoms, which were in turn supported
by the patient's recent history of ingesting undercooked microwaved
fish and a positive serologic study for the IgE specific for Anisakis
simplex. The final confirmation was received by the use of endoscopy
to positively confirm the presence of the larvae.
Case Study #4: "Intestinal
anisakiasis requiring surgical treatment in an emergency setting".
Moschella C.M., Mattiucci S., Borromeo C., Fazzini D., Ruggiero M.I.,
De Angelis G. Emergency Department (DEA 2) University Hospital "Azienda
Policlinico Umberto I" University "La Sapienza" Rome - Italy
"A 37-year old woman was admitted in an emergency
setting to our Emergency Department (ED) with a diagnosis of acute
appendicitis. Physical exam showed tenderness in the right lower abdomen.
The plain abdomen X-ray demonstrated the presence of several levels
in the small intestine and sonography detected distension of the right
colon and presence of ascites. According to the diagnosis of appendicitis
we performed a McBurney incision. The surgical exploration revealed
a large mass in the caecum region and therefore a mid-line laparotomy
was performed. Right colectomy with ileo-transverse T-T anastomosis
was performed. The postoperative course was uneventful and the patient
was discharged after ten days. Pathology revealed the presence of
several eosinophilic granuloma due to Anisakis larva."
(Taken from http://www-cdu.dc.med.unipi.it/eates4/Abstracts/Miscellanea/241.htm)
Case Study #5: "Eosinophilic
gastritis due to Anisakis: a case report". (2000) Esteve
C, Resano A. Allergol Immunopathol, Jan-Feb; 28 (1): p. 21-23.
A 14-year-old boy in Pamplona, Spain, presented with
a diagnosed case of eosinophilic gastritis after an endoscopy and
biopsy after recurrent abdominal pain. He also exhibited a type I
hypersensitivity mechanism against Anisakis simplex, which
was concluded by a prick test, antigen specific IgE determination,
and an antigen specific histamine release test. The patient subsequently
eliminated seafood from his diet, and has been asymptomatic for two