In the May issue of Gastroenterology, Kaori Ikegami et al describe the case of a 47-year-old man who arrived at the emergency department with severe epigastric pain. He reported eating raw chub mackerel (sashimi) 7 hours before the onset of his symptoms.
His vital signs were stable, his body temperature was 36.9°C, and he had no abdominal tenderness despite severe spontaneous pain.
However, he had an increased white blood cell count (13.8 × 10³/μL) and concentration of C-reactive protein (1.03 mg/dL), and a low-density area around the lower esophagus was visible.
A computed tomography scan of the patient’s chest revealed edematous thickening of the entire length of the esophageal wall surrounded by fluid.
Ikegami et al found the patient to have anisakiasis—a parasitic disease caused by anisakid nematodes (worms) that invade the stomach wall or intestine of humans. The disease occurs when infective larvae are ingested from fish or squid that humans eat raw or undercooked. The authors state that the disease is well described in many countries, particularly in Japan, where raw fish are commonly consumed as sushi and sashimi. Most cases in Japan are characterized by gastric and intestinal involvement.
The infection can be treated by removal of the larvae during endoscopy or surgery (see figure). For this patient, the larvae were removed with forceps, and there were no abnormalities in the stomach or duodenum. His symptoms disappeared completely, and he was discharged on day 3 of hospitalization.