title: Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients.
abstract: OBJECTIVE
  To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis.
  
  
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 1753-3, Ara-1-dong, Jeju-si, Jeju Special Self-Governing Province, 690-716, Korea.
authors.forename: Jeong Sub
authors.initials: JS
authors.lastname: Lee
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Seung Hyoung
authors.initials: SH
authors.lastname: Kim
authors.forename: Ji Kang
authors.initials: JK
authors.lastname: Park
authors.forename: Gukmyung
authors.initials: G
authors.lastname: Choi
authors.forename: Im Kyung
authors.initials: IK
authors.lastname: Hwang
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Jeong
authors.forename: Chang Lim
authors.initials: CL
authors.lastname: Hyun
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Song
authors.forename: Young-Bae
authors.initials: YB
authors.lastname: Chung
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000469:parasitology; D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000469:parasitology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017129:Anisakiasis / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000469:parasitology*; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide