Last update:
16-Oct-2008

Myiasis is caused by the larvae (maggots) of dipterous flies, when they invade living or decaying tissue. Intestinal myiasis occurs when eggs or larvae are ingested with food and are not killed in the stomach or intestine. The case is reported of intestinal myiasis in a young Greek farmer, who presented in the General Hospital of Mytilene with symptoms and signs of acute abdomen, vomiting, severe abdominal pain and small bowel obstruction. The abdominal X-ray showed intestinal obstruction and the presence of air-liquid levels. The patient underwent surgical excision of the terminal part of ileum (about 12 cm in length), which was intensively inflammed and edematous. The histological examination showed eosinophilic infiltration of all intestinal layers extending into the perienteric fat. Parasites identified as fly larvae were detected deep in the intestinal wall, between the smooth muscle layer and the serosa. The identification of these invasive larvae was based on the presence of spines on the parasite cuticle. To the authors' knowledge, this is the first report of full thickness intestinal invasion by fly larvae, with manifestations of intestinal obstruction and acute abdomen mimicking eosinophilic gastroenteritis. Intestinal myiasis, though very rare, should be considered (a) as a possible cause of eosinophilic infiltration of the intestinal wall and (b) in the differential diagnosis of eosinophilic gastroenteritis, for which absence of parasitic disease is a prerequisite.

Key words: Eosinophilic gastroenteritis, Intestinal myiasis.