Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients
Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients
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DOI：
10.1007/s00261-014-0106-0
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发表时间：
2014-06-01
影响因子：
--
通讯作者：
Chung, Young-Bae
中科院分区：
文献类型：
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作者：
Lee, Jeong Sub;Kim, Bong Soo;Chung, Young-Bae
为探讨小肠异尖症的临床和CT表现，收集2005年至2012年19例小肠异尖症患者的腹部CT资料。所有这些患者均通过异尖孢菌素血清学试验（n = 18）或病理学检查（n = 1）进行诊断。他们的医疗记录进行了审查，以确定临床结果。由两名放射科医师回顾性分析CT图像，以评估受累肠壁的特征和辅助发现。所有患者均表现为急性发作的剧烈腹痛以及最近吃过生鱼的病史。从吃鱼到腹痛发作的平均时间间隔为1.7天。18名患者接受了保守治疗，并在住院后7天内症状消退。1例患者因假定小肠缺血接受手术探查。病变部位包括回肠（16/19，84%）和空肠（3/19，16%）。所有患者均有环周肠壁增厚（平均0.8 cm），受累肠长度居中（平均7.9 cm）。小肠梗阻16例（84%）。17名患者（89%）出现目标体征，16名患者（84%）出现腹水，特别是在病灶周围区域，15名患者（79%）出现肠系膜水肿。在急腹症的鉴别诊断中，应考虑小肠异壁畸形，以避免患者在最近吃生鱼后出现腹痛时不必要的手术，同心圆肠壁增厚伴回肠靶征、病灶周围腹水以及CT上可见肠梗阻。
To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis.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.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%).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.