A case of chronic abdominal pain related to the ingestion of raw seafood: Anisakiasis.

A previously healthy 40-year-old man presented to the emergency department with acute abdominal pain and repeated bilious vomiting that began the previous day and progressively worsened. On examination, he was afebrile and hemodynamically stable, with mild diffuse abdominal tenderness and no peritoneal signs. Laboratory studies showed leukocytosis with neutrophil predominance, an elevated C-reactive protein, and no eosinophilia. Contrast-enhanced abdominal computed tomography revealed segmental thickening of the small bowel wall with localized obstruction, without evidence of a mechanical cause such as adhesions, masses, or strangulation. A detailed dietary history disclosed that the patient had consumed raw flounder obtained directly from a fisherman three days earlier. Given the coastal endemic setting and high clinical suspicion, serologic testing for Anisakis-specific IgE was performed, yielding markedly elevated levels (>100 UA/mL), supporting the diagnosis of allergic-mediated intestinal Anisakiasis. The patient was treated conservatively in the ED observation unit with nasogastric decompression, bowel rest, and intravenous hydration. Over the next 48 h, symptoms resolved, vomiting ceased, and bowel function returned to normal. He was discharged on a cooked-seafood-only diet. At follow-up, he reported complete resolution of chronic intermittent abdominal discomfort that had been present for several years. Repeat IgE testing demonstrated a substantial decline, correlating with sustained symptom relief. This case underscores the importance for emergency physicians in endemic areas to consider allergic intestinal anisakiasis in patients presenting with unexplained small bowel obstruction, to obtain a thorough dietary history, and to utilize specific IgE testing to guide diagnosis and avoid unnecessary surgical intervention.