Intestinal anisakiasis: CT imaging findings-a 10-year descriptive study in a single center.

PURPOSE: The aim of this study was to retrospectively review cases of intestinal anisakiasis diagnosed by CT over a 10-year period and to evaluate imaging findings associated with the disease. METHODS: This retrospective study included 71 patients with clinical suspicion of intestinal anisakiasis in whom an abdominopelvic computed tomography (CT) was performed at a single institution between June 2011 and December 2021. To identify the cases, we used medical term search engines and the hospital's radiology case database. Clinical information was gathered from the medical records. A radiologist with five years of experience reviewed and analyzed the CT images to determine the characteristic findings of intestinal anisakiasis. RESULTS: The study included 47 confirmed cases of intestinal anisakiasis. The mean age of the patients was 52 years (range 18-87 years), being more frequent in men than women (26:21). All patients reported ingestion of raw fish, most commonly anchovies in vinegar (30/47, 63,8%). Abdominal pain was the predominant symptom, accompanied by nausea, vomiting, and occasionally fever. The most common clinical suspicions were intestinal obstruction (14/47, 29,8%) and appendicitis (10/47, 21,3%), whereas intestinal anisakiasis was suspected in only 2 cases prior to imaging. CT showed thickening of the bowel wall with submucosal edema in all patients, predominantly involving the ileum (43/47, 91,5%), usually in a relatively long segment (mean of 17,5 cm, range 10-30 cm). Simultaneous involvement of multiple bowel segments was observed in 16 cases (34%). Intestinal obstruction with dilatation of proximal loops (33/47, 70,2%), ascites (45/47, 95,7%), and mesenteric fat striation (32/47, 68,1%) were also common findings. CONCLUSION: This study demonstrates the value of computed tomography in suggesting the diagnosis of intestinal anisakiasis, which often presents with nonspecific clinical manifestations. The characteristic CT findings that provide diagnostic clues are bowel wall thickening with submucosal edema, typically involving a long segment of the ileum, with signs of intestinal obstruction, ascites, and mesenteric fat striation. Simultaneous involvement of several intestinal segments (typically the gastric antrum and right colon) is an additional finding to be considered and may provide a diagnostic clue.