Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

126 Anisakiasis Anorectal Tumors

specific therapy

Indications

■Gastric form: patients with moderate or severe pain, nausea

■Intestinal form: If surgical indications exist

Treatment Options

■Gastric form: Gastroscopic removal of worms. Pretreatment with H2

blocker may help.

Side Effects & Complications

■Gastric form: same as complications of gastroscopy

■Intestinal form: peritonitis, complications of surgery

■Contraindications to treatment: absolute: asymptomatic patients,

and patients with worm migration to mouth and no other symptoms

■Contraindications to treatment: relative: mild symptoms

follow-up

During Treatment

■Monitor symptoms, possible surgical problems.

Routine

■Educate patient about mode of acquisition.

complications and prognosis

■Gastric form: Generally there is recovery, worms die off or removed,

inflammation subsides.

■Intestinal form: Intestinal perforation, local abscess, peritoneal

signs. Surgery is frequent with these presentations. Prognosis good

after surgery.

Anorectal Tumors....................................

MARK A. VIERRA, MD

history & physical

History

■Adenocarcinoma of rectum most common anorectal malignancy

(∼98%)

■Arises in adenomas

■Incidence increases w/ age, uncommon before age 40

■Approximately equal incidence men & women