Masui Nobutaka, Fujima Noriyuki, Hasegawa Takeshi, Kigawa Sanshiro, Kagei Noboru, Nagashima Kazuo, Shimizu Yozo
Department of Medicine, Sapporo Higashi-Tokushukai Hospital, Sapporo, Japan.
Pathol Int. 2006 Jun;56(6):345-9. doi: 10.1111/j.1440-1827.2006.01970.x.
A 51-year-old woman with a history of eating raw fish over a period of 2 weeks developed a progressive abdominal pain and leukocytosis with signs of small bowel obstruction. Eosinophilia was not detected in the peripheral blood. The patient underwent surgery to clarify the possibility of ileus. Partial small bowel near the ileum was trapped by a peritoneal strand and was strangulated for approximately 30 cm in length with congestion and edema. The removal of the strand easily released the strangulation and the small bowel returned to a normal appearance. Pathologically, the strand consisted of granulomatous inflammation with a wide zone of necrosis containing a dead ghost feature of a parasite in its center. The necrosis was surrounded by palisading spindle cells with largely lymphocytic infiltration and a few eosinophils. In the parasite, there presented the polymyalian type muscle layer, ventricles and Renette cells, which suggested that the parasite is compatible with the third stage larva of Anisakis type I, leading to the diagnosis of ectopic anisakidosis. It should be noted that, on rare occasions, Anisakis larva migrans can form a peritoneal strand with a wide zone of necrosis and cause strangulation ileus, especially in populations with the habit of eating raw fish.
一名51岁女性，有两周生食鱼类的病史，出现进行性腹痛和白细胞增多，并伴有小肠梗阻体征。外周血未检测到嗜酸性粒细胞增多。患者接受手术以明确肠梗阻的可能性。回肠附近的部分小肠被一条腹膜束带缠住，长度约30厘米的肠段发生绞窄，伴有充血和水肿。移除束带后，绞窄很容易解除，小肠恢复正常外观。病理检查显示，束带由肉芽肿性炎症组成，中央有一个广泛的坏死区域，其中含有寄生虫的死亡残骸特征。坏死区域被栅栏状梭形细胞包围，大量淋巴细胞浸润，并有少量嗜酸性粒细胞。在寄生虫中，可见多肌型肌层、心室和肾细胞，提示该寄生虫与I型异尖线虫第三期幼虫相符，从而诊断为异位异尖线虫病。需要注意的是，在极少数情况下，异尖线虫幼虫移行症可形成带有广泛坏死区域的腹膜束带并导致绞窄性肠梗阻，尤其是在有生食鱼类习惯的人群中。
