Small bowel occlusion due to Anisakis infection

Abstract is not required for Letter to the Editoris not required for Letter to the Editor (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(9):622–623. www.ijcasereportsandimages.com Zippi et al. 622 CASE REPORT OPEN ACCESS Small bowel occlusion due to Anisakis infection Maddalena Zippi, Daniela De Nitto, Giuseppe Grassi, Ingrid Febbraro

38.9°C, blood pressure was 120/70 mmHg, while the pulse rate was 120/min and the respiratory acts 18/min. Increased white blood cell count (16.43/mm 3 ; neutrophils 88.9%) and index of inflammation (CRP 6.0 mg/dL) were present. On physical exam, the abdomen was poorly negotiable with signs of peritoneal reaction. The patient underwent an abdominal radiography and an abdominal computed tomography (CT) scan, showed the presence of marked air-fluid levels. The diagnosis of small intestinal obstruction was run and the patient had to have surgery, consisting of removing the terminal ileum ( Figure 1). The bowel was erythematous and markedly stenotic with enlarged lymph nodes in the adjacent mesentery. The day after the operation, Anisakis antibodies IgG and IgA were tested and both of them turned out to be positive. Based on these findings, a diagnosis of small bowel obstruction caused by Anisakis was made. A drug treatment with albendazole (800 mg daily) for 10 days was administered. The patient recovered well and was discharged seven days after the operation.
In conclusion, the symptoms of intestinal Anisakis are non-specific and the patients often are misdiagnosed. According to our opinion, this is the very first case of a small bowel obstruction due to Anisakis infection occurred in Italy.

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