A Patient With Extra-Gastrointestinal Anisakiasis Diagnosed Preoperatively as Torsion of Accessory Spleen

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  • Shirane Kazuki
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Masumoto Kouji
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Chiba Fumiko
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Sasaki Takato
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Ono Kentarou
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Jimbo Takahiro
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Gotoh Chikashi
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Urita Yasuhisa
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Shinkai Toko
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
  • Takayasu Hajime
    Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba

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Other Title
  • 副脾捻転の術前診断で摘出術を施行した消化管外アニサキス症の1例
  • 症例報告 副脾捻転の術前診断で摘出術を施行した消化管外アニサキス症の1例
  • ショウレイ ホウコク フクヒネンテン ノ ジュツゼン シンダン デ テキシュツジュツ オ シコウ シタ ショウカカン ガイ アニサキスショウ ノ 1レイ

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Abstract

<p>A 14-year-old boy who developed left-side abdominal pain three months ago visited a previous clinic owing to repeated pain. Abdominal contrast CT showed a 10 mm mass near the spleen, and it was suspected as a torsion of the accessory spleen. He was referred to our hospital, and contrast MRI showed the same mass near the spleen. The mass was not enhanced, suggesting that an accessory spleen was infarcted. Two months later, laparoscopic resection was performed. During the operation, we found a mass in the greater omentum near the spleen and resected it. It was a white and solid mass measuring 10 × 10 mm. Histopathological examination showed that the mass was a granuloma with neutrophil infiltration, and a necrotized worm was found in the granuloma. The worm had a Y-shaped lateral cord and a renette cell indicating that it was an Anisakis larva; therefore, we diagnosed the patient as having extra-gastrointestinal anisakiasis. In the first infiltration of Anisakis larvae to the body, a few larvae may penetrate the abdominal wall and die in the abdominal cavity. Extra-gastrointestinal anisakiasis develops when the larva forms a granuloma in the abdominal cavity. The occurrence frequency of this disease is only 0.5% of all types of anisakiasis, and the preoperative diagnosis is very difficult. Thus, most cases were found accidentally during the operation, but a few were found because of abdominal pain due to the granulomas. From our experience, clinicians should consider the possibility that the granuloma due to extra-gastrointestinal anisakiasis may also cause abdominal pain.</p>

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