title: Anisakiasis presenting to the ED: clinical manifestations, time course, hematologic tests, computed tomographic findings, and treatment.
abstract: BACKGROUND
  The prevalence of anisakiasis is rare in the United States and Europe compared with that in Japan, with few reports of its presentation in the emergency department (ED). This study describes the clinical, hematologic, computed tomographic (CT) characteristics, and treatment in gastric and small intestinal anisakiasis patients in the ED.
  
  
  METHODS
  We retrospectively reviewed the data of 83 consecutive anisakiasis presentations in our ED between 2003 and 2012. Gastric anisakiasis was endoscopically diagnosed with the Anisakis polypide. Small intestinal anisakiasis was diagnosed based on both hematologic (Anisakis antibody) and CT findings.
  
  
  RESULTS
  Of the 83 cases, 39 had gastric anisakiasis and 44 had small intestinal anisakiasis based on our diagnostic criteria. Although all patients had abdominal pain, the gastric anisakiasis group developed symptoms significantly earlier (peaking within 6 hours) than the small intestinal anisakiasis group (peaking within 48 hours), and fewer patients with gastric anisakiasis needed admission therapy (5% vs 57%, P<.01). All patients in the gastric and 40 (91%) in the small intestinal anisakiasis group had a history of raw seafood ingestion. Computed tomographic findings revealed edematous wall thickening in all patients, and ascites and phlegmon of the mesenteric fat were more frequently observed in the small intestinal anisakiasis group.
  
  
  CONCLUSIONS
  In the ED, early and accurate diagnosis of anisakiasis is important to treat and explain to the patient, and diagnosis can be facilitated by a history of raw seafood ingestion, evaluation of the time-to-symptom development, and classic CT findings.
authors.affiliation: Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima, Japan. Electronic address: taktak4080@gmail.com.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takabayashi
authors.affiliation: Department of Emergency and Critical Care Medicine, St Luke's International Hospital, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mochizuki
authors.affiliation: Department of Emergency and Critical Care Medicine, St Luke's International Hospital, Tokyo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Otani
authors.affiliation: Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Nishiyama
authors.affiliation: Department of Emergency and Critical Care Medicine, St Luke's International Hospital, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ishimatsu
mesh_terms: D000328:Adult; D000818:Animals; D017129:Anisakiasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D017163:Anisakis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis / Q000000981:diagnostic imaging; D008297:Male; D012189:Retrospective Studies; D017747:Seafood / Q000009:adverse effects / Q000469:parasitology; D013272:Stomach Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000469:parasitology; D014041:Tokyo / Q000453:epidemiology; D014057:Tomography, X-Ray Computed