[Acute intestinal bleeding due to Taenia solium infection]

Parasite infections of the digestive tract are a rare cause of acute haemorrhage in Western countries. We report here on a case of acute intestinal bleeding due to Taenia solium infection diagnosed at surgery. A 79-year-old white female patient was admitted to our institution for instable angina and severe anaemia secondary to acute intestinal bleeding. The patient's medical history was positive for long-standing microcytic anaemia. A recent diagnostic work-up had revealed the presence of chronic erosive antral gastritis and colonic diverticular disease without acute bleeding. On admission to our department the patient underwent antegrade bowel endoscopy which showed a bleeding site 120 cm caudad to the Treitz ligament in the absence of ulcers and/or neoplastic lesions. The patient was eventually referred to surgery for suspected intestinal angiodysplasia. At surgery no gross lesions of the stomach, bowel or colon were observed. We then performed a custom enterotomy 120 cm caudad to the Treitz ligament and discovered a 250-cm-long tapeworm. The parasite was removed with the aid of a second enterotomy 60 cm cephalad to the previous one and the entire bowel was explored with an intraoperative fiberoptic endoscope. Histology of the parasite revealed a T. solium species. The postoperative course was uneventful and the patient was discharged on postoperative day 10 with a prescription of 2 g/day niclosamide. No recurrent digestive bleeding has so far been reported after a follow-up of 8 months. T. solium infection is a common cause of chronic microcytic anaemia in tropical and subtropical areas. In Western countries intestinal parasite infections are rarely taken into account in the diagnostic work-up of patients affected with chronic anaemia and/or acute digestive bleeding. The mechanisms responsible for acute intestinal bleeding in tapeworm infections are poorly understood and could be related to parasite-induced erosions of the bowel wall or be secondary to manipulations occurring during diagnostic manoeuvres.