Ito Yuichiro, Ikematsu Yoshito, Yuzawa Hiroyuki, Nishiwaki Yoshirou, Kida Hideo, Waki Shinji, Uchimura Masayuki, Ozawa Takachika, Iwaoka Takeshi, Kanematsu Takashi
Department of Surgery, Hamamatsu Medical Center, Nagasaki, Japan.
Asian J Surg. 2007 Jan;30(1):67-71. doi: 10.1016/S1015-9584(09)60131-7.
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.
通常，胃异尖线虫病的诊断是在内镜检查时通过识别异尖线虫幼虫来做出的。我们报告一例以气腹为表现的胃异尖线虫病病例。一名70岁的日本女性因腹胀和腹痛入院。立位胸部X线平片显示膈下存在游离气体。初步诊断为穿孔性腹膜炎并进行了急诊剖腹手术。在剖腹手术中，在胃小弯附近胃上半部分的前壁发现一个4厘米的边界清晰的红色肿块，并进行了部分胃切除术。组织学诊断显示在肉芽肿中心可见一个异物，推测为异尖线虫幼虫的一部分。在浆膜面，有纤维蛋白和中性粒细胞的腹膜炎组织学证据。此外，抗异尖线虫幼虫免疫球蛋白G抗体检测呈阳性。由于切除区域存在嗜酸性肉芽肿和变性的异尖线虫幼虫，怀疑为慢性胃异尖线虫病。因此，我们将此病例解释为基于慢性胃异尖线虫病的急性胃穿孔。
