Enteric anisakiasis is a relatively rare disease that is difficult to diagnose preoperatively. We report a case of small bowel obstruction caused by enteric anisakiasis in a 59-year-old Japanese man who presented with abdominal pain a few hours after eating sliced, raw fish. Because of signs of an intestinal obstruction, a laparotomy was performed. Focal thickening and stenosis of the ileocecal region were seen about 100 cm from the end of the ileum and the lesion was excised. We found a moving anisakis thrusting its head into the mucosa of the excised small intestine. Histopathological examination revealed the infiltration of eosinophils in all layers of the intestinal wall and severe edema. Enteric anisakiasis is very rare, and its diagnosis is usually only made after laparotomy. Nevertheless, when signs of acute abdomen develop after the ingestion of raw fish, such as sushi or sashimi, the possibility of enteric anisakiasis should be borne in mind.
A 73-year-old woman visited our hospital because of increasing abdominal distension and lower abdominal pain. On abdominal computed tomography (CT), hepatic portal venous gas (HPVG) and pneumatosis intestinalis of the small intestine were found. HPVG caused by intestinal necrosis was diagnosed, and an emergency laparotomy was thus performed. Necrosis of the small intestine over a 40-cm area from the ileocaecal region toward the mouth was found, and the lesion was resected. Histopathologically, haemorrhagic necrotic enteritis was diagnosed. The patient is alive as of the seventieth day after operation. The prognosis of intestinal necrosis accompanied by HPVG and pneumatosis intestinalis is poor. The presence of HPVG suggests the occurrence of a serious lesion in the abdominal cavity. Therefore, appropriate treatment should be performed immediately.
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