[Severe segmental colitis due to anisakiasis. Unusual manifestation of a rare infection in Germany]. / Schwere segmentale Kolitis durch eine Anisakiasis. Ungewöhnliche Manifestation einer in Deutschland seltenen Infektion.

HISTORY AND CLINICAL FINDINGS: A 43 years old worker of a fish factory was admitted for spasmodic lower abdominal pain lasting for some hours. Physical examination revealed diffuse abdominal tenderness with a maximum in the right upper and lower abdomen. INVESTIGATIONS: Laboratory values showed a slight rise in leucocytes with otherwise normal inflammation parameters. In abdominal ultrasonography some free fluid in the gallbaldder region and an impressing thickening of the walls of the ascending and transverse colon were found. A CT scan described an "intraluminal process" and a pericolic infiltration. TREATMENT AND COURSE: Laparoscopy was performed and revealed a swelling of the whole right colon with pronounced edema. After an extension to laparotomy and colotomy, massive mucosal edema was seen (explaining the intraluminal process); furthermore, there was a filiform whitish structure of around 15 mm length in the colonic mucosa. Histology ascertained the macroscopic diagnosis of a small worm which was identified as an anisakis larva. After intraoperative removal of the worm and an anthelminthic therapy the patient's complaints and the impressing mucosal edema disappeared completely. CONCLUSIONS: Anisakiasis is a very rare infection in Germany. In single cases, a history of the place of work may be helpful in diagnosis. Usually the larva penetrate into gastric or intestinal mucosa. The case presented here illustrates the possibility of an anisakiasis infection in severe and otherwise unexplainable segmental colitis, especially with a history of a possible ingestion of raw fish.