Chronic Gastric Anisakiasis Presenting as Pneumoperitoneum

Abstract

Typically, the diagnosis of gastric anisakiasis is made at endoscopy with the identification of anisakis larvae. We report a case of gastric anisakiasis presenting as pneumoperitoneum. A 70-year-old Japanese woman was admitted to our hospital with abdominal fullness and pain. Plain chest X-ray in the upright position showed the presence of free gas below the diaphragm. A tentative diagnosis of perforation peritonitis was made and an emergency laparotomy was performed. At laparotomy, a 4 cm, circumscribed red mass was noted on the anterior wall of the upper body of the stomach near the lesser curvature and a partial gastrectomy was carried out. The histological diagnosis showed a foreign body, assumed to be a part of anisakis larvae, seen in the centre of the granuloma. On the serosal aspect, there was histological evidence of peritonitis with fibrin and neutrophils. In addition, an antianisakis larvae immunoglobulin G antibody test was positive. Chronic gastric anisakiasis was suspected because of the presence of eosinophilic granuloma in the resected area and denatured anisakis larvae. Thus, we interpret this case as gastric perforation acutely based on chronic gastric anisakiasis.

Chronic gastric anisakiasis provoking a bleeding gastric ulcer

“…Subsequently, the granuloma usually decreases in size and gradually disappears [2,3]. Rarely, patients with strong allergic reactions develop stomach perforation and bleeding [5,6]. …”

Anisakiasis Causing Acute Dysentery in Malaysia

“…Nevertheless, there have been many instances where the diagnosis was only made after viewing histological sections from resected bowel after laparotomy. 3,15,18 The most prominent morphological feature from a cross section of the nematode are the Y-shaped lateral epidermal cords. 3,15 However, morphological identification is dependent on how well the worm has been conserved.…”

“…3 However, in cases of surgical complications, laparotomy or bowel resection may have to be performed. 3,7,18 Corticosteroids are helpful to reduce the inflammatory response to the worm or when dealing with allergic reactions. 10,23 Recently, conservative therapy has been found to be successful in treating intestinal anisakiasis.…”

Utilidad de la anamnesis y de las técnicas inmunológicas en el diagnóstico de la anisakidosis en pacientes con abdomen agudo

“…El diagnóstico se confirma al observar la larva, cuando es expectorada o extraída mediante endoscopia de zonas accesibles (esófago, estómago, colon); sin embargo, es más difícil cuando la larva migra hacia el intestino delgado o es extra-gastrointestinal, requiriendo con frecuencia cirugía (2,(12)(13)(14)(15)(16)(17), o cuando la infestación se hace cró-nica y la larva es destruida por el sistema inmune (7,(18)(19)(20). El diagnóstico inmunológico se basa en la prueba cutánea con extracto crudo de larva de A. simplex y en la determinación de IgE específica frente a este (21)(22)(23)(24).…”