Valle Joaquín, Lopera Elisa, Sánchez María Eugenia, Lerma Rocío, Ruiz Javier López
Department of Emergency Medicine, Hospital "Valle de los Pedroches," Calle Juan Del Rey Calero, S/N, Pozoblanco 14400, Córdoba, Spain.
J Med Case Rep. 2012 Apr 23;6:114. doi: 10.1186/1752-1947-6-114.
Anisakidosis, human infection with nematodes of the family Anisakidae, is caused most commonly by Anisakis simplex. Acquired by the consumption of raw or undercooked marine fish or squid, anisakidosis occurs where such dietary customs are practiced, including Japan, the coastal regions of Europe and the United States. Rupture of the spleen is a relatively common complication of trauma and many systemic disorders affecting the reticuloendothelial system, including infections and neoplasias. A rare subtype of rupture occurring spontaneously and arising from a normal spleen has been recognized as a distinct clinicopathologic entity. Herein we discuss the case of a woman who presented to our institution with appendicitis secondary to Anisakis and spontaneous spleen rupture.
We report the case of a 53-year-old Caucasian woman who presented with hemorrhagic shock and abdominal pain and was subsequently found to have spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. She underwent open surgical resection of the splenic rupture and the appendicitis without any significant postoperative complications. Histopathologic examination revealed appendicitis secondary to Anisakis simplex and splenic rupture of undetermined etiology.
To the best of our knowledge, this report is the first of a woman with the diagnosis of spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. Digestive anisakiasis may present as an acute abdomen. Emergency physicians should know and consider this diagnosis in patients with ileitis or colitis, especially if an antecedent of raw or undercooked fish ingestion is present. Spontaneous rupture of the spleen is an extremely rare event. Increased awareness of this condition will enhance early diagnosis and effective treatment. Further research is required to identify the possible risk factors associated with spontaneous rupture of the spleen.
异尖线虫病是人体感染异尖线虫科线虫所致，最常见的病原体是简单异尖线虫。通过食用生的或未煮熟的海鱼或鱿鱼而感染，在有此类饮食习惯的地区，包括日本、欧洲和美国的沿海地区，都会发生异尖线虫病。脾破裂是创伤以及许多影响网状内皮系统的全身性疾病（包括感染和肿瘤）相对常见的并发症。一种罕见的自发性脾破裂亚型，起源于正常脾脏，已被确认为一种独特的临床病理实体。在此，我们讨论一名因简单异尖线虫继发阑尾炎并自发性脾破裂而就诊于我院的女性病例。
我们报告一例53岁的白种女性病例，该患者因出血性休克和腹痛就诊，随后被发现患有简单异尖线虫继发的自发性脾破裂和阑尾炎。她接受了脾破裂和阑尾炎的开放手术切除，术后无任何严重并发症。组织病理学检查显示为简单异尖线虫继发的阑尾炎和病因不明的脾破裂。
据我们所知，本报告是首例诊断为简单异尖线虫继发自发性脾破裂和阑尾炎的女性病例。消化性异尖线虫病可能表现为急腹症。急诊医生对于患有回肠炎或结肠炎的患者应了解并考虑这一诊断，尤其是如果患者有食用生的或未煮熟鱼类的既往史。脾自发性破裂是极其罕见的事件。提高对这种情况的认识将有助于早期诊断和有效治疗。需要进一步研究以确定与脾自发性破裂相关的可能危险因素。
