A Student Ate Gas Station Sushi For Breakfast. This Is What Happened To His Stomach

Patient Presentation

• Patient: TB, 22-year-old male
• Symptoms: Facial swelling, shortness of breath, hives, severe right-sided lower abdominal pain (last 3 days)
• Preliminary Diagnosis: Possible appendicitis, possible allergic reaction

Background and History

• Lifestyle: College student; scavenges expired food
• Food Sources: Discarded groceries, gas station sushi (favoring days when not fresh)
• Initial Symptoms: Began after eating expired gas station pizza; severe abdominal pain, facial swelling, difficulty breathing
• Initial Diagnosis: Potentially caused by expired pizza; suspect appendicitis

Initial Examination and Diagnosis

• Physical Exam: Abdominal tenderness, guarding, rebound tenderness (right lower quadrant)
• Tests: Blood test (borderline high WBC count), CT scan (inflammation, possible appendicitis)
• Intervention: Appendectomy
• Findings: Appendix appeared normal, not significantly inflamed
• Advice: Stop scavenging food, consider a cafeteria meal plan
• Patient Response: Continued scavenging, experienced abdominal pain, cramping, constipation

Subsequent Severe Reaction

• Incident: Bought gas station sushi, experienced rash, shortness of breath, cramping immediately after eating
• Condition: Anaphylactic shock, severely low blood pressure (60/30)
• Treatment: Epinephrine, fluid resuscitation
• Observation: Radiograph showed bowel blockage, high WBC count, confirming infection
• Surgical Findings: Thickened, inflamed intestinal walls, presence of Anisakis Simplex (roundworm)

Detailed Discussion on Anisakis Simplex

• Lifecycle: Parasite in marine mammals (e.g., whales, dolphins); transmitted through eggs in feces, ingested by crustaceans, then fish
• Human Infection: Occurs from eating raw/undercooked infected fish; attempts to burrow into human stomach lining
• Prevalence: High prevalence in Japan (up to 98% in certain fish), also found in Europe and the US (1 in 13 chance in salmon)

Clinical Symptoms and Diagnosis Challenges

• Symptoms: Abdominal pain, nausea, allergic reactions
• Confusion with Other Conditions: Can mimic Crohn's disease, appendicitis, and other GI conditions
• Diagnostic Hints: Recent intake of raw fish, sushi

TB’s Case Review

• Initial Missteps: Failed to mention sushi consumption; initial infection likely misdiagnosed as appendicitis
• Learning: Consumption of improperly handled raw fish led to parasitic infection
• Outcome: Permanent GI tract damage but eventual recovery
• Conclusion: Be cautious about sourcing and handling of raw fish, better to avoid dubious food sources

General Advice

• Safety: Eating sushi from reputable sources is generally safe
• Precautions: Avoid unverified food sources, poorly handled sushi

Takeaway Message

• Careful Consumption: Importance of food safety and handling to avoid infections like Anisakis
• Personal Care: Be vigilant about what you eat, especially raw/undercooked fish.