Abdominal Imaging

, Volume 39, Issue 3, pp 452–458 | Cite as

Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients

  • Jeong Sub Lee
  • Bong Soo Kim
  • Seung Hyoung Kim
  • Ji Kang Park
  • Gukmyung Choi
  • Im Kyung Hwang
  • Sun Young Jeong
  • Chang Lim Hyun
  • Hyun Joo Song
  • Young-Bae Chung



To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis.

Materials and methods

Nineteen patients with small-bowel Anisakiasis and who underwent abdominal CT between 2005 and 2012 were enrolled in our study. All of these patients were diagnosed using either a serologic test for Anisakiasis (n = 18) or by pathology (n = 1). Their medical records were reviewed in order to determine the clinical findings. CT images were retrospectively reviewed by two radiologists to evaluate the characteristics of the involved bowel wall and the ancillary findings.


All patients had presented with the acute onset of severe abdominal pain as well as a history of having recently eaten raw fish. The mean time interval from eating the fish to the onset of abdominal pain was 1.7 days. Eighteen patients were treated conservatively and experienced resolution of their symptoms within seven days of hospitalization. One patient underwent surgical exploration for presumed small-bowel ischemia. The sites of involvement included the ileum (16/19, 84%) and jejunum (3/19, 16%). All patients had circumferential bowel-wall thickening (mean, 0.8 cm) with an intermediate length of involved bowel (mean, 7.9 cm). Small-bowel obstruction occurred in 16 patients (84%). The target sign was present in 17 patients (89%), ascites, particularly in the perilesional area, in 16 patients (84%), and mesenteric edema in 15 patients (79%).


Small-bowel Anisakiasis should be considered in the differential diagnosis of acute abdomen in order to avoid unnecessary surgery when patients present with abdominal pain after having recently eaten raw fish, concentric bowel-wall thickening with the target sign in the ileum, perilesional ascites, as well as bowel obstruction seen on CT.


Anisakiasis Small bowel CT Raw fish 



We thank Bonnie Hami, MA (USA) for her editorial assistance in preparing the manuscript.


  1. 1.
    Macpherson CN (2005) Human behaviour and the epidemiology of parasitic zoonoses. Int J Parasitol 35(11–12):1319–1331. doi: 10.1016/j.ijpara.2005.06.004 PubMedCrossRefGoogle Scholar
  2. 2.
    Yasunaga H, Horiguchi H, Kuwabara K, Hashimoto H, Matsuda S (2010) Clinical features of bowel anisakiasis in Japan. Am J Trop Med Hyg 83(1):104–105. doi: 10.4269/ajtmh.2010.09-0780 PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Hochberg NS, Hamer DH (2010) Anisakidosis: perils of the deep. Clin Infect Dis 51(7):806–812. doi: 10.1086/656238 PubMedCrossRefGoogle Scholar
  4. 4.
    Chai JY, Darwin Murrell K, Lymbery AJ (2005) Fish-borne parasitic zoonoses: status and issues. Int J Parasitol 35(11–12):1233–1254. doi: 10.1016/j.ijpara.2005.07.013 PubMedCrossRefGoogle Scholar
  5. 5.
    Takabe K, Ohki S, Kunihiro O, et al. (1998) Anisakidosis: a cause of intestinal obstruction from eating sushi. Am J Gastroenterol 93(7):1172–1173. doi: 10.1111/j.1572-0241.1998.00356.x PubMedCrossRefGoogle Scholar
  6. 6.
    Kagei N, Orikasa H, Hori E, Sannomiya A, Yasumura Y (1995) A case of hepatic anisakiasis with a literal survey for extra-gastrointestinal anisakiasis. Jpn J Parasitol 44:346–351.Google Scholar
  7. 7.
    Kim T, Song HJ, Jeong SU, et al. (2013) Comparison of the clinical characteristics of patients with small bowel and gastric anisakiasis in Jeju Island. Gut Liver 7(1):23–29. doi: 10.5009/gnl.2013.7.1.23 PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kusuhara T, Watanabe K, Fukuda M (1984) Radiographic study of acute gastric anisakiasis. Gastrointest Radiol 9(4):305–309.PubMedCrossRefGoogle Scholar
  9. 9.
    Nakata H, Takeda K, Nakayama T (1980) Radiological diagnosis of acute gastric anisakiasis. Radiology 135(1):49–53.PubMedGoogle Scholar
  10. 10.
    Kanematsu M, Hoshi H (1997) Benefit of immediate endoscopy after radiography for anisakiasis. AJR Am J Roentgenol 168(4):1114–1115.PubMedCrossRefGoogle Scholar
  11. 11.
    Hsiu JG, Gamsey AJ, Ives CE, D’Amato NA, Hiller AN (1986) Gastric anisakiasis: report of a case with clinical, endoscopic, and histological findings. Am J Gastroenterol 81(12):1185–1187.PubMedGoogle Scholar
  12. 12.
    Sakai K, Ohtani A, Muta H, et al. (1992) Endoscopic ultrasonography findings in acute gastric anisakiasis. Am J Gastroenterol 87(11):1618–1623PubMedGoogle Scholar
  13. 13.
    Kakizoe S, Kakizoe H, Kakizoe K, et al. (1995) Endoscopic findings and clinical manifestation of gastric anisakiasis. Am J Gastroenterol 90(5):761–763.PubMedGoogle Scholar
  14. 14.
    Haubrich WS, Schaffner F, Berk JE, Bockus HL (1995) Bockus gastroenterology, vol 5. Philadelphia: SaundersGoogle Scholar
  15. 15.
    Yoon SW, Yu JS, Park MS, et al. (2004) CT findings of surgically verified acute invasive small bowel anisakiasis resulting in small bowel obstruction. Yonsei Med J 45(4):739–742.PubMedGoogle Scholar
  16. 16.
    Nawa Y, Hatz C, Blum J (2005) Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis 41(9):1297–1303. doi: 10.1086/496920 PubMedCrossRefGoogle Scholar
  17. 17.
    Pacios E, Arias-Diaz J, Zuloaga J, et al. (2005) Albendazole for the treatment of anisakiasis ileus. Clin Infect Dis 41(12):1825–1826. doi: 10.1086/498309 PubMedCrossRefGoogle Scholar
  18. 18.
    Moore DA, Girdwood RW, Chiodini PL (2002) Treatment of anisakiasis with albendazole. Lancet 360(9326):54PubMedCrossRefGoogle Scholar
  19. 19.
    Kim WK, Song SY, Cho OK, et al. (2011) CT findings of small bowel anisakiasis: analysis of four cases. J Korean Soc Radiol 64:167–171.Google Scholar
  20. 20.
    Masui N, Fujima N, Hasegawa T, et al. (2006) Small bowel strangulation caused by parasitic peritoneal strand. Pathol Int 56(6):345–349. doi: 10.1111/j.1440-1827.2006.01970.x PubMedCrossRefGoogle Scholar
  21. 21.
    McKerrow JH, Sakanari J, Deardorff TL (1988) Anisakiasis: revenge of the sushi parasite. N Engl J Med 319(18):1228–1229.PubMedGoogle Scholar
  22. 22.
    Shirahama M, Koga T, Ishibashi H, et al. (1992) Intestinal anisakiasis: US in diagnosis. Radiology 185(3):789–793.PubMedGoogle Scholar
  23. 23.
    Sugimachi K, Inokuchi K, Ooiwa T, Fujino T, Ishii Y (1985) Acute gastric anisakiasis. Analysis of 178 cases. JAMA: J Am Med Assoc 253(7):1012–1013.CrossRefGoogle Scholar
  24. 24.
    Ido K, Yuasa H, Ide M, et al. (1998) Sonographic diagnosis of small intestinal anisakiasis. J Clin Ultrasound: JCU 26(3):125–130.PubMedCrossRefGoogle Scholar
  25. 25.
    Kim LS, Lee YH, Kim S, Park HR, Cho SY (1991) A case of anisakiasis causing intestinal obstruction. Kisaengch’unghak Chapchi Korean J Parasitol 29(1):93–96.CrossRefGoogle Scholar
  26. 26.
    Matsui T, Iida M, Murakami M, et al. (1985) Intestinal anisakiasis: clinical and radiologic features. Radiology 157(2):299–302PubMedGoogle Scholar
  27. 27.
    Shirahama M, Koga T, Uchida S, et al. (1990) Colonic anisakiasis simulating carcinoma of the colon. AJR Am J Roentgenol 155(4):895.PubMedCrossRefGoogle Scholar
  28. 28.
    Aneiros-Fernandez J, Molina MC, Pelegrina RR, et al. (2010) Intestinal eosinophilic: anisakiasis. J Med Cases 1(3):84–86.Google Scholar
  29. 29.
    Scheirey CD, Scholz FJ, Shortsleeve MJ, Katz DS (2011) Angiotensin-converting enzyme inhibitor-induced small-bowel angioedema: clinical and imaging findings in 20 patients. AJR Am J Roentgenol 197(2):393–398. doi: 10.2214/AJR.10.4451 PubMedCrossRefGoogle Scholar
  30. 30.
    Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH (1970) Eosinophilic gastroenteritis. Medicine 49(4):299–319.PubMedCrossRefGoogle Scholar
  31. 31.
    Yun MY, Cho YU, Park IS, et al. (2007) Eosinophilic gastroenteritis presenting as small bowel obstruction: a case report and review of the literature. World J Gastroenterol: WJG 13(11):1758–1760,PubMedGoogle Scholar
  32. 32.
    Vitellas KM, Bennett WF, Bova JG, et al. (1995) Radiographic manifestations of eosinophilic gastroenteritis. Abdom Imaging 20(5):406–413.PubMedCrossRefGoogle Scholar
  33. 33.
    Hayasaka H, Ishikura H, Takayama T (1971) Acute regional ileitis due to anisakis larvae. Int Surg 55(1):8–14.PubMedGoogle Scholar
  34. 34.
    Matsuo S, Azuma T, Susumu S, et al. (2006) Small bowel anisakiosis: a report of two cases. World J Gastroenterol: WJG 12(25):4106–4108PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jeong Sub Lee
    • 1
  • Bong Soo Kim
    • 1
  • Seung Hyoung Kim
    • 1
  • Ji Kang Park
    • 1
  • Gukmyung Choi
    • 1
  • Im Kyung Hwang
    • 1
  • Sun Young Jeong
    • 1
  • Chang Lim Hyun
    • 2
  • Hyun Joo Song
    • 3
  • Young-Bae Chung
    • 4
  1. 1.Department of RadiologyJeju National University School of Medicine, Jeju National University HospitalJeju-siKorea
  2. 2.Department of PathologyJeju National University School of MedicineJeju-siKorea
  3. 3.Department of Internal MedicineJeju National University School of MedicineJeju-siKorea
  4. 4.Department of ParasitologyJeju National University School of MedicineJeju-siKorea

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