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Revista Española de Enfermedades Digestivas

versión impresa ISSN 1130-0108

Rev. esp. enferm. dig. vol.102 no.1 Madrid ene. 2010




Another multiple gastric anisakiasis case

Otro caso de anisakiasis gástrica múltiple



Key words: Anisakis. Worm. Parasite.

Palabras clave: Anisakis. Larva. Parásito.



Dear Editor,

Recently Amo Peláez et al. reported two simultaneous cases of multiple gastric and dudoenal anisakiasis (1). Because of this and because we have images available we want to report the recent case of 50 years old woman with 48 hours intense abdominal pain, nausea and vomiting. At physical examination abdomen was distended, pain was located in right upper quadrant and there was no sign of peritonitis. Blood count showed 29,920 leucocytes and 91% PMN without eosinophilia. Simple abdominal radiography was unremarkable and abdominal ultrasound demonstrated scarce perihepatic fluid. A TC (Fig. 1), and some hours later an upper digestive endoscopy, were performed. With endoscopy we recognized numerous (more than eight) anisakis worms forming a heap and localized in incisura, antrum and pylorus (Fig. 2) where there was a shortly deep ulcer with a parasitic worm penetrating the gastric mucosa. All the worms were removed with biopsy forceps and we verified there was resistance because of the adherence of the worms to the mucosa. Duodenal bulb and distal duodenum were free of worms. We insisted on asking the patient about the ingestion of undercooked fish and she confirmed it. She had no pruritus or rash. Abdominal pain disappeared a few hours after endoscopy. Serology for anisakis was positive (EIA: IgG 104, IgE 76). A colonoscopy was also performed and it was unremarkable.



It is unusual in our country the description of more than one worm in gastric anisakiasis diagnosed with endoscopy and is even less frequent the description of multiple larvas like in Amo Peláez et al. cases (1) and in ours. In Repiso et al. series a worm was detected in 5 of 10 patients with gastric symptoms and in all of them there was just one larva (2). In González Quijada et al. series the parasitic worm was detected with endoscopy in 6 patients, in 2 of them there were more than one worm (2 worms in one case and 3 in other case) (3). Ji Hun et al. described a case with 4 parasitic worms (4). Other published cases in our country find a unique larva (5,6). It has not been frequent the description of multiple anisakiasis till now.


L. I. Fernández-Salazar1, B. Guantes-de-Vigo2, J. Herreros-Rodríguez3, C. Abril-Vega3,
J. Calabia-del-Campo2, F. de-la-Calle-Valverde1, B. Velayos-Jiménez1 and J. M. González-Hernández1

Departments of 1Digestive Diseases, 2Radiodiagnosis, and 3General Surgery. University Hospital of Valladolid. Spain



1. Amo Peláez M, Muñoz Codoceo C, Martínez Montiel P, Sánchez Gómez F, Castellano G, Solís Herruzo JA. Anisakiasis múltiple. Rev Esp Enferm Dig 2008; 9: 581-2.        [ Links ]

2. Repiso Ortega A, Alcántara Torres M, González Frutos C, de Artaza Varasa T, Rodríguez Merlo R, Valle Muñoz J, et al. Anisakiasis gastrointestinal. Estudio de una serie de 25 pacientes. Gastroenterol Hepatol 2003; 26(6): 341-6.        [ Links ]

3. González Quijada S, González Escudero R, Arias García L, Gil Martín AR, Vicente Serrano J, Corral Fernández. Manifestaciones digestivas de la anisakiasis: descripción de 42 casos. Rev Clin Esp 2005; 205(7): 311-5.        [ Links ]

4. Noh JH, Kim GJ, Kim SM, Ock MS, Park MI, Goo JY. A case of acute gastric anisakiasis provoking severe clinical problems by multiple infection. Korean J Parasitol 2003; 41(2): 97-100.        [ Links ]

5. Bao Pérez F, Álvarez Rubio M, Martí Cabane J. Anisakis simplex sobre ulcus en paciente con Billroth II. Rev Esp Enferm Dig 2005; 97(6): 533-4.        [ Links ]

6. Del Olmo L, De la Calle F, Fernández L, González de Canales MP, Arranz T. Anisakiasis. A propósito de 6 casos. Boletín de la Asociación Española de Endoscopia Digestiva 2000; 12: 51.        [ Links ]

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