- Email: [email protected]
An Unusual Cause of Severe Epigastric Pain
Accepted Manuscript An unusual cause of severe epigastric pain Kaori Ikegami, MD, Yasuo Hirose, MD, Osamu Yoneyama, MD
PII: DOI: Reference:
S0016-5085(17)36037-7 10.1053/j.gastro.2017.08.021 YGAST 61367
To appear in: Gastroenterology Accepted Date: 11 August 2017 Please cite this article as: Ikegami K, Hirose Y, Yoneyama O, An unusual cause of severe epigastric pain, Gastroenterology (2017), doi: 10.1053/j.gastro.2017.08.021. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Title page □Title
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An unusual cause of severe epigastric pain
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□Authors
(e-mail: [email protected])
Yasuo Hirose, MD
(e-mail: [email protected])
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Kaori Ikegami, MD
Osamu Yoneyama, MD (e-mail: [email protected])
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□Affiliations
Department of Emergency and Critical Care Medicine,
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Niigata City General Hospital
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463-7 Shumoku, Chuuouku, Niigata, 950-1197, Japan
□Corresponding author Kaori Ikegami, MD
Department of Emergency and Critical Care Medicine, Niigata City General Hospital 463-7 Shumoku, Chuuouku, Niigata, 950-1197, Japan
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Phone: (81)25-281-5151
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□□All authors have no conflicts of interest to declare.
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Email: [email protected]
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FAX: (81)25-281-5187
□□Written informed consent was obtained from the patient for publication of this case
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report and accompanying images.
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Question A 47-year-old man with an unremarkable medical history presented to our emergency
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department with severe epigastric pain. He reported eating raw chub mackerel pieces (sashimi) 7 hours before symptom onset. His vital signs were stable and his body
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temperature was 36.9ºC. He had no abdominal tenderness despite severe spontaneous
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pain. Laboratory findings revealed an elevated white blood cell count (13.8 × 10³/µl) and C-reactive protein concentration (1.03 mg/dl). No ischemic change was detected on an electrocardiogram. An abdominopelvic computed tomographic examination revealed no abnormalities in the abdominopelvic cavity; however, a low-density area around the
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lower esophagus was visible. We also ordered chest computed tomography, which showed edematous thickening of the entire length of the esophageal wall surrounded by
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fluid (Fig. A and B).
What is the diagnosis?
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Answer: esophageal anisakiasis Anisakiasis, which is caused by nematodes of the genus Anisakis, is a zoonotic
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infectious disease transmitted to humans through raw seafood. It has long been described in many countries,1 particularly in Japan,2 where the habit of eating raw fish
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such as sushi and sashimi is well established. Most cases in Japan are characterized by
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gastric and intestinal involvement.1,2 Localized esophageal anisakiasis is unusual.
Our patient underwent upper gastrointestinal endoscopy with a clinical history suggestive of anisakiasis. The endoscopic findings revealed invasion of the esophageal
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mucosa by an Anisakis larva (Fig. C), which was subsequently removed with forceps. The patient had no obvious abnormalities in the stomach or duodenum. His symptoms
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disappeared completely, and he was discharged on day 3 of hospitalization.
References
1. Carmo J, Marques S, Bispo M, et al. Anisakiasis: a growing cause of abdominal pain! BMJ Case Rep 2017; doi:10.1136/bcr-2016-218857. 2. Fuchizaki U, Nishikawa M. Images in clinical medicine. Gastric anisakiasis. N Engl J Med 2016; 375:e11.
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PII: DOI: Reference:
S0016-5085(17)36037-7 10.1053/j.gastro.2017.08.021 YGAST 61367
To appear in: Gastroenterology Accepted Date: 11 August 2017 Please cite this article as: Ikegami K, Hirose Y, Yoneyama O, An unusual cause of severe epigastric pain, Gastroenterology (2017), doi: 10.1053/j.gastro.2017.08.021. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title page □Title
RI PT
An unusual cause of severe epigastric pain
SC
□Authors
(e-mail: [email protected])
Yasuo Hirose, MD
(e-mail: [email protected])
M AN U
Kaori Ikegami, MD
Osamu Yoneyama, MD (e-mail: [email protected])
TE D
□Affiliations
Department of Emergency and Critical Care Medicine,
EP
Niigata City General Hospital
AC C
463-7 Shumoku, Chuuouku, Niigata, 950-1197, Japan
□Corresponding author Kaori Ikegami, MD
Department of Emergency and Critical Care Medicine, Niigata City General Hospital 463-7 Shumoku, Chuuouku, Niigata, 950-1197, Japan
ACCEPTED MANUSCRIPT
Phone: (81)25-281-5151
M AN U
□□All authors have no conflicts of interest to declare.
SC
Email: [email protected]
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FAX: (81)25-281-5187
□□Written informed consent was obtained from the patient for publication of this case
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EP
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report and accompanying images.
ACCEPTED MANUSCRIPT
Question A 47-year-old man with an unremarkable medical history presented to our emergency
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department with severe epigastric pain. He reported eating raw chub mackerel pieces (sashimi) 7 hours before symptom onset. His vital signs were stable and his body
SC
temperature was 36.9ºC. He had no abdominal tenderness despite severe spontaneous
M AN U
pain. Laboratory findings revealed an elevated white blood cell count (13.8 × 10³/µl) and C-reactive protein concentration (1.03 mg/dl). No ischemic change was detected on an electrocardiogram. An abdominopelvic computed tomographic examination revealed no abnormalities in the abdominopelvic cavity; however, a low-density area around the
TE D
lower esophagus was visible. We also ordered chest computed tomography, which showed edematous thickening of the entire length of the esophageal wall surrounded by
AC C
EP
fluid (Fig. A and B).
What is the diagnosis?
ACCEPTED MANUSCRIPT
Answer: esophageal anisakiasis Anisakiasis, which is caused by nematodes of the genus Anisakis, is a zoonotic
RI PT
infectious disease transmitted to humans through raw seafood. It has long been described in many countries,1 particularly in Japan,2 where the habit of eating raw fish
SC
such as sushi and sashimi is well established. Most cases in Japan are characterized by
M AN U
gastric and intestinal involvement.1,2 Localized esophageal anisakiasis is unusual.
Our patient underwent upper gastrointestinal endoscopy with a clinical history suggestive of anisakiasis. The endoscopic findings revealed invasion of the esophageal
TE D
mucosa by an Anisakis larva (Fig. C), which was subsequently removed with forceps. The patient had no obvious abnormalities in the stomach or duodenum. His symptoms
AC C
EP
disappeared completely, and he was discharged on day 3 of hospitalization.
References
1. Carmo J, Marques S, Bispo M, et al. Anisakiasis: a growing cause of abdominal pain! BMJ Case Rep 2017; doi:10.1136/bcr-2016-218857. 2. Fuchizaki U, Nishikawa M. Images in clinical medicine. Gastric anisakiasis. N Engl J Med 2016; 375:e11.
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