Diagnostic Value of Colonoscopy in Intestinal Diphyllobothrium latum Infection

Abstract

Diphyllobothrium latum is an intestinal tapeworm that infests mammals. This report presents a case with small intestinal D latum infection that was successfully diagnosed and treated with endoscopy and Gastrografin. A 19-year-old man consulted the hospital because a tapeworm was spontaneously discharged in his feces. Colonoscopy disclosed a flat, yellow-white tapeworm at the terminal ileum (Figure A). To remove this tapeworm by endoscopy, it was grasped with a retrieval basket and gently and slowly pulled out through the anus to avoid tearing it (Figures B and C). However, it could not be completely removed (Figure D). The worm was identified as D latum on the basis of the morphologic characteristics. In 1986, Waki et al1Waki K. Oi H. Takahashi S. et al.Successful treatment of Diphyllobothrium latum and Taenia saginata infection by intraduodenal “Gastrografin” injection.Lancet. 1986; 2: 1124-1126Abstract PubMed Scopus (15) Google Scholar reported that a gastrointestinal contrast medium, Gastrografin, was effective for extirpating D latum, and several groups also reported its usefulness.2Fujita M. Koga H. Iida M. et al.The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal Diphyllobothrium latum infection: report of a case.Am J Gastroenterol. 2002; 97: 2468-2470Crossref PubMed Scopus (9) Google Scholar, 3Ko S.B. Ohmiya N. Nakamura M. et al.Observation of deworming process in intestinal Diphyllobothrium latum parasitism by gastrografin injection into jejunum through double-balloon enteroscope.Am J Gastroenterol. 2008; 103: 2149-2150Crossref PubMed Scopus (6) Google Scholar Just after the diagnosis of the D latum infection, 200 mL of Gastrografin (Nihon Shering, Osaka, Japan) was injected into the third portion of duodenum by using an upper gastrointestinal fiberscope. It is important to inject Gastrografin immediately into the jejunum to treat such a tapeworm. Using endoscopy is an easy way to deliver large amounts of Gastrografin to the duodenum.3Ko S.B. Ohmiya N. Nakamura M. et al.Observation of deworming process in intestinal Diphyllobothrium latum parasitism by gastrografin injection into jejunum through double-balloon enteroscope.Am J Gastroenterol. 2008; 103: 2149-2150Crossref PubMed Scopus (6) Google Scholar When the Gastrografin passed rapidly through the small intestine, the worm was carried away from the jejunum toward the colon by intestinal peristalsis (Figure E). In the discharge, an actively moving worm, measuring approximately 200 cm in length with an intact scolex (circle) and neck, was noted (Figure F). The whole course of the tapeworm discharge was observed radiologically, which took only a short time (35 minutes). There was no evidence of relapse during the next 9 months. Treatments with anthelmintics occasionally have toxic effects on the host, require the specific preparation of the patient before treatment, and cause the death of the tapeworm. However, the Gastrografin method can attack the tapeworm in its active form and remove it with an intact scolex. It is important to remove the scolex to avoid a recurrence of infection. Gastrografin injection is therefore considered to be easy to perform as well as a safe and effective treatment in comparison to the use of anthelmintics.