A Hemorrhagic Shock Caused by Intestinal Anisakiasis

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A 55-year-old man experienced acute abdominal pain and massive melena. He was admitted to our affiliated hospital, but the melena repeatedly occurred. After bleeding heavily, he went into shock and suffered a cardiac arrest. Emergency cardiopulmonary resuscitation was performed, and he was resuscitated after a few minutes. He was transported to our emergency medical center to receive critical care and to determine the cause of his bleeding. Although, several examinations were performed, the cause of the melena could not be identfied. Therefore, an emergency operation was performed to determine the source of the bleeding. A nodule was found in the intestinal wall during the operation. A pathological examination revealed Anisakis spp. and eosinophilic infiltration in the nodule. The final diagnosis was intestinal anisakiasis. Identifying the existence of Anisakis in the intestinal canal is very difficult using conventional examinations, and immediate surgical intervention may be required to make a diagnosis and save the patient's life. This case suggests that anisakiasis should be considered in patients complaining of acute abdominal pain and massive melena.
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