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CASE REPORT
Colonic anastomosis leakage related to taenia saginata infestation
Alper SozutekI,
Corresponding author
dralpers@hotmail.com

Tel.: 90 324-3374300/1189
, Tahsin ColakII, Ahmet DagII, Ozgur TurkmenogluII
I Mersin University Medical Faculty, Dept. of General Surgery, Division of Gastroenterologic Surgery, Mersin, Turkey.
II Mersin University Medical Faculty, Dept. of General Surgery, Mersin, Turkey.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Helminth and protozoa infections remain an important public health problem in tropical and underdeveloped countries&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> The adult stage of <span class="elsevierStyleItalic">Taenia saginata</span> is one of the most common pathogenic cestode in humans&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> This tapeworm is transmitted by raw beef consumption&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Infected individuals may remain asymptomatic for years&#44; and the only symptom may be the spontaneous passage of proglottids&#46; However&#44; nonspecific symptoms&#44; such as vague abdominal pain&#44; nausea&#44; vomiting&#44; diarrhea&#44; and weight loss&#44; can be present&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> Although the tapeworm seems to be a benign parasitic disease&#44; it can lead to serious surgical gastrointestinal system &#40;GIS&#41; complications that are seldom reported in the medical literature&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2-11</a> However&#44; according to our intensive literature search we believe that this report is the first case of colonic anastomotic leakage related to <span class="elsevierStyleItalic">T&#46; saginata</span> infestation following a right hemicolectomy procedure&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">Case Report</span><p id="para20" class="elsevierStylePara elsevierViewall">A 49-year-old male patient was admitted to our emergency service with a one-week history of abdominal pain&#46; Despite using analgesics&#44; abdominal discomfort progressed to generalized abdominal pain&#44; nausea and vomiting&#46; Upon physical examination&#44; generalized abdominal tenderness and rebound tenderness were detected&#46; Laboratory parameters revealed leukocytosis &#91;14&#46;3 &#215; 103&#47;&#956;l &#40;range 4&#46;5-11&#41;&#93; and a high C-reactive protein level of 247&#46;12 mg&#47;l &#40;range &#60;5&#41;&#46; No disorder was determined from other parameters&#46; Plain x-ray abdominal radiography was unremarkable&#46; Abdominal ultrasonography &#40;US&#41; and computerized tomography &#40;CT&#41; revealed dilated small intestines in the right lower abdominal quadrant with pericecal free fluid that was compatible with a possible perforated or plastron appendicitis &#40;<a class="elsevierStyleCrossRef" href="#fig1">Fig&#46; 1</a>&#41;&#46; Urgent surgery was planned after obtaining the patient&#39;s consent&#46; On exploratory laparotomy&#44; a complicated mass formation composed of the appendix&#44; cecum and sigmoid colon was identified in the right lower abdominal quadrant&#46; After separation of the sigmoid colon&#44; a perforated cecal area of necrosis and the appendix were identified&#46; A right hemicolectomy and a hand-sewn ileotransversostomy were performed&#46; On the third postoperative day&#44; the patient&#39;s vital signs began to deteriorate and an enteric fistula was observed at the drainage tube&#46; Therefore&#44; a second-look laparotomy was performed&#46; On exploration&#44; an anastomotic leakage associated with a segment of the tapeworm was identified &#40;<a class="elsevierStyleCrossRef" href="#fig2">Fig&#46; 2</a>&#41;&#46; The anastomosis was ligated&#44; and an end ileostomy was performed due to the generalized fecal peritonitis&#46; The postoperative course was uneventful&#46; The patient received a single dose of niclosamide &#40;4&#215;500 mg&#41; 10 days after surgery&#46; The histopathologic examination of the specimen was read as infectious colitis&#44; and the parasitological examination revealed <span class="elsevierStyleItalic">T&#46; saginata</span>&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="fig2"></elsevierMultimedia></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para30" class="elsevierStylePara elsevierViewall">The adult stage of <span class="elsevierStyleItalic">T&#46; saginata</span> is one of the most common pathogenic cestodes in humans&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Reasons including tourism&#44; migration and military operations may lead to the spread of this parasitic infection to unaffected communities&#46; Therefore&#44; this should be considered a worldwide problem&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> Humans are the definitive host for this tapeworm&#46; Infection with <span class="elsevierStyleItalic">T&#46; saginata</span> is transmitted by eating raw beef that contains cysticerci&#44; which are larval forms of the parasite&#46; Most infected individuals are asymptomatic&#44; unless they become aware of the proglottids passing in their stool&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> Complaints from patients&#44; such as feeling discomfort in the anal region while discharging the proglottidis and noticing a worm in their stool or underwear&#44; should lead to a suspicion of taeniasis&#46; However&#44; no problems related to the tapeworm were mentioned by our patient&#46;</p><p id="para40" class="elsevierStylePara elsevierViewall">The tapeworm attaches to the mucosal surface using four suckers on its anterior scolex&#46; Migration of the proglottids to the GIS lumen can lead to rare serious acute surgical conditions&#44; such as acute appendicitis&#44; Meckel&#39;s diverticulitis&#44; pancreatitis&#44; cholecystitis&#44; liver abscess&#44; obstruction and perforation of the intestine and anastomotic leakage&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2-11</a> These complications are usually identified during surgery&#46; Unfortunately&#44; we were not able to observe the tapeworm during the first operation&#46; The colonic perforation was suspected to be the result of a perforated plastron appendicitis&#46; Repeat laparotomy incidentally identified the clinical explanation&#44; and the cause of the colonic perforation was later explained by the pathology report&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">Compared with small bowel perforations&#44; colonic perforation due to <span class="elsevierStyleItalic">T&#46; saginata</span> is a very rare complication that has been reported only once in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a> Invasion of the small bowel by the parasite before reaching the large bowel may be a possible explanation&#46; Surprisingly&#44; colonic anastomotic leakage related to <span class="elsevierStyleItalic">T&#46; saginata</span> is not reported in the medical literature&#44; and to the best of our knowledge&#44; this case is the first&#46; Due to early dehiscence of the anastamosis and the parasite being extracted from the colonic side&#44; we might speculate that the possible cause for leakage was related to an obstruction of the distal part of the anastomosis by the parasite&#46; Therefore&#44; taeniasis should be considered an unusual and unexpected cause of colonic anastomotic leakage&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">Identification of the tapeworm is based on stool examination for ova&#46; The perianal region can be examined using a cellophane-tape swab to detect ova as well&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;7</a> Serologic tests are not helpful&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4</a></p><p id="para70" class="elsevierStylePara elsevierViewall">Taeniasis is preventable by improving sanitation and strict inspection of beef prior to sale&#46; Beef should be cooked to 60&#176;C for over 5 min before consumption&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2&#44;3</a> Either praziquantel &#40;5-10 mg&#47;kg&#41; or niclosamide &#40;4&#215;500 mg&#41; can be used for medical treatment&#46; Both are effective and free from side effects&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Surgery is recommended only for the treatment of complications&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para80" class="elsevierStylePara elsevierViewall">In conclusion&#44; taeniasis is a very rare entity that should be considered in the differential diagnosis as the cause of an acute abdomen with unusual surgical complications&#46; It should be kept in mind as a very rare possible cause of early colonic anastomosis leakage&#46; Although surgery is indicated for complications&#44; prevention is the best treatment method&#46;</p></span></span>"
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos