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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 109-111

A 23-year-old male with intussusception caused by parasitic flatworm infection acquired by eating sushi


1 Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
2 University of Tennessee Health Science Center, College of Medicine, Nashville, Murfreesboro, TN, USA

Date of Submission02-Feb-2016
Date of Acceptance06-Apr-2016
Date of Web Publication2-Jun-2016

Correspondence Address:
Rebecca Jeanmonod
St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-5568.183335

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  Abstract 

A 23-year-old male presented to our emergency department with symptoms of intermittent abdominal discomfort, cyclic vomiting, and decreased appetite. The patient had a history of recurrent flatworm infection without recent travel, but a history of often consuming undercooked seafood in the form of sushi. The patient was found to have small bowel intussusception on computed tomography. Intussusception is a rare diagnosis with a bimodal distribution favoring the pediatric population with an increase in incidence again among the elderly. The pathophysiology of the condition requires the presence of a “lead point” which is typically a tumor in the elderly patient, but there is no identified common cause of intussusception in the sporadic cases of intussusception in healthy young adults. Intussusception should be considered in young adults with cyclical abdominal pain, and consideration should be given to helminthic infection in those with endemic travel or raw food consumption.
The following core competencies are addressed in this article: Patient care, Medical knowledge.

Keywords: Abdominal pain, helminthic infection, intussusception


How to cite this article:
Phelps J, Evans D, Jeanmonod R. A 23-year-old male with intussusception caused by parasitic flatworm infection acquired by eating sushi. Int J Acad Med 2016;2:109-11

How to cite this URL:
Phelps J, Evans D, Jeanmonod R. A 23-year-old male with intussusception caused by parasitic flatworm infection acquired by eating sushi. Int J Acad Med [serial online] 2016 [cited 2019 Jul 23];2:109-11. Available from: http://www.ijam-web.org/text.asp?2016/2/1/109/183335


  Introduction Top


Intussusception occurs when bowel invaginates into itself, causing pain, and partial to complete obstruction. The majority of cases is identified in small children and can be idiopathic. There is a second peak of incidence later in life, typically due to bowel pathology with the formation of a lead point from which the intussusception occurs. We report the rare occurrence of intussusception in a young adult caused by helminthic infection likely contracted from eating sushi.


  Case Report Top


A 23-year-old male presented to a tertiary health care center with a complaint of intermittent abdominal discomfort, cyclic vomiting, and decreased appetite. The patient stated that he would awaken feeling nauseated and had nonbloody, nonbilious vomiting nearly every morning for the last month. His symptoms had been persistent throughout the day for the prior 5 days. His nausea was relieved with vomiting, but his appetite has been limited during the day due to worsening symptoms with eating. He also noted a 5-pound unintentional weight loss over the course of his illness. The patient denied fevers and chills. The patient denied current abdominal pain but stated that he did experience brief periodic episodes of abdominal discomfort. The patient denied hematochezia, melena, diarrhea, and constipation.

The patient's medical history was significant for a “flatworm” infection treated successfully 6 months before this visit, but the patient had been noticing worms in his stool again. The patient had not had recent travel but had a history of eating undercooked foods, primarily sushi. The patient had no other medical history or surgical history.

On physical exam, the patient was well appearing with normal vital signs. His heart and lung exams were unremarkable. His abdomen was not tender, and there was no masses or organomegaly noted. He had bowel sounds in all four quadrants.

In the emergency department (ED), the patient was given intravenous fluids and antiemetics with some symptomatic relief. A computed tomography (CT) abdomen/pelvis was ordered to rule out partial bowel obstruction secondary to a large worm burden. The CT [Figure 1] and [Figure 2] demonstrated a short segment small bowel intussusception without evidence of obstruction. General Surgery was consulted and recommended antihelminthic medications and discharge with surgical clinic follow-up. Follow-up with the patient 4 months after his ED visit revealed that the patient had complete remission of symptoms with a 10 days course of albendazole and had not had any complications or recurrence of symptoms.
Figure 1: Coronal slice of computed tomography showing short segment small bowel intussusception in the left upper quadrant

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Figure 2: Sagittal cut from computed tomography demonstrating intussusception

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  Discussion Top


Helminthic infections are common in the developing world but have historically been a rare occurrence in developed countries. The epidemiology of helminthic infections may be changing in industrialized nations as demand for seafood from areas endemic for zoonotic disease increases and with increasing cultural interest in consuming raw or undercooked fish.[1],[2] Although most people with a helminthic infection present with diarrhea, vomiting, and abdominal pain, helminthic infections have been known to cause intussusception.

Intussusception is a rare diagnosis in general. When identified, it is typically diagnosed in the pediatric population accounting for 2/3 of all cases of intussusception. The majority of nonpediatric cases occur in elderly patients, and 90% are caused by an identifiable pathologic lesion.[3],[4] The finding of intussusception in a healthy young adult, outside of the bimodal distribution of the incidence of intussusception is exceedingly uncommon in developed countries.

Unlike in children, adult intussusception results in complete bowel obstruction in only 20% of cases.[5] Patients may present with a protracted course of illness in a subacute fashion as in our patient. Patients often present with nausea, vomiting, diarrhea, and abdominal cramps or pain with a duration of symptoms typically >2 weeks. These symptoms often lead the provider to consider other intra-abdominal pathology. As such, the diagnosis of intussusception in adults is often made by CT scan to rule out other intra-abdominal processes.[6]

Unlike in children, in whom the standard of care is a reduction of the intussusception with air contrast enema, adult intussusception is classically treated surgically. This is because of the high incidence of malignancy as a lead point for the intussusception. This standard may be changing, as in the era of high-resolution imaging, intussusception that is asymptomatic or idiopathic is being increasingly recognized.[7] In intussusception believed to be secondary to helminthic infection, a trial of antihelminthic medications with close follow-up with surgical services is a reasonable approach.


  Conclusion Top


Given changing societal dietary trends, there is increasing probability that ED providers will be seeing patients with intestinal helminthic infections. The ED provider should place a priority on eliciting a dietary history and consider the possibility of complications from these infections in patients at risk. In adult patients with cyclical gastrointestinal symptoms, intussusception should be a diagnostic consideration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Craig N. Fish tapeworm and sushi. Can Fam Physician 2012;58:654-8.  Back to cited text no. 1
    
2.
Scholz T, Garcia HH, Kuchta R, Wicht B. Update on the human broad tapeworm (genus Diphyllobothrium), including clinical relevance. Clin Microbiol Rev 2009;22:146-60.  Back to cited text no. 2
    
3.
Wang N, Cui XY, Liu Y, Long J, Xu YH, Guo RX, et al. Adult intussusception: A retrospective review of 41 cases. World J Gastroenterol 2009;15:3303-8.  Back to cited text no. 3
    
4.
Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: A retrospective review. Dis Colon Rectum 2006;49:1546-51.  Back to cited text no. 4
    
5.
Haas EM, Etter EL, Ellis S, Taylor TV. Adult intussusception. Am J Surg 2003;186:75-6.  Back to cited text no. 5
    
6.
Prater JM, Olshemski FC. Adult intussusception. Am Fam Physician 1993;47:447-52.  Back to cited text no. 6
    
7.
Onkendi EO, Grotz TE, Murray JA, Donohue JH. Adult intussusception in the last 25 years of modern imaging: Is surgery still indicated? J Gastrointest Surg 2011;15:1699-705.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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