Acute pancreatitis caused by Anisakis

摘要

A 63-year-old man presented with upper abdominal pain 36 hours after ingesting sliced raw fish (Sebastes schlegeli Hilgendorf). Laboratory analyses revealed the following: serum amylase, 3619 IU/L (normal 43-127 IU/L) and total bilirubin 6.0 mg/dL (0.2-1.2 mg/dL). Abdominal CT revealed a high-density lesion involving the extrahepatic bile duct and gallbladder, swelling of the pancreas, and peripancreatic fluid (A). Acute biliary pancreatitis was suspected, and duodenoscopy revealed GI bleeding (B, left) and a swollen ampulla of Vater with migration of a nema-tode into the ampulla (B, middle and right). The nema-tode was removed by biopsy forceps and identified as an Anisakis larva. ERCP revealed obstruction of the extrahepatic bile duct because of a blood clot (C, left and right, arrows).