アニサキス幼虫による急性局所性腸炎―疫学的および臨床的観察

Acute Regional Enteritis Due to Anisakis Larva

　回腸末端炎あるいは腸蜂窩織炎などと呼ばれてきた疾患のなかには，蛔虫などの線虫の腸管壁への穿入が関与しているもののあることが指摘されてきたが，1960年van Thielがニシンに寄生していた線虫をアニサキス幼虫と同定し，本幼虫による急性局所性腸炎を報告して以来，本邦においても大鶴，吉村，石倉らにより広範な研究が行なわれてきている．本症はアニサキス幼虫を包蔵した海産魚類の生食により感染することから日常の食生活との関係が深く，さらに急性虫垂炎，腸閉塞症によく似た症状を呈するなど臨床上重要な疾患と考えられる．さきに石倉らにより全国調査が行なわれ，そのなかで本症が地域的に種々な特色を有していることが報告されているが，われわれは数年来手術所見から急性局所性腸炎と診断した例について，発症前に食べた海産魚類の種類，症状や局所所見などについて調査を続けてきたので，現在までに得られた結果につき報告する．

　We have clinically studied the role of Anisakis larva on acute regional enteritis in Kanazawa, and abtained the follow ing results:

　It was made clear that 51 of 60 patients with acute regional enteritis had eaten raw fish-Sashimi or Sushi-before the onsets of the symptoms. The kinds of fishes were yellowtail, Spanish mackerel, mackerel and others. The patients were most often seen in winter.

　As generally these fish are caught in the Japan Sea and are eaten usually in winter, this tendency corresponds well with the results of our investigations.

　The lesions were located mostly in the terminal ileum. The macroscopical pictures were edema, thickness of the wall and inflammatory changes, but in several cases they were located in the middle part of ileum and showed more severe symtoms and pathological changes.

　We have performed intestinal resections in 7 cases and in 4 of them we have observed Anisakis larvae invading mucous membrane. In no-resected cases the patients were treated with antibiotics and no recurrence was experienced.