Images in Clinical Medicine

Taenia in the Gastrointestinal Tract

Wen-Shen Liao, M.D., and Ming Jong Bair, M.D.

N Engl J Med 2007; 357:1028September 6, 2007

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Tapeworm Segments Identified on Colonoscopy.

A healthy 60-year-old woman presented with hematemesis and melena, which she had had for 1 day. Her physical examination was unremarkable, as were the results of routine blood tests. On upper gastroduodenal endoscopy, a tapeworm was seen, along with multiple erosions and active bleeding from ulcers in the stomach and duodenum. She did not use nonsteroidal antiinflammatory drugs, and Helicobacter pylori was not found. After treatment with praziquantel and a proton-pump inhibitor, the bleeding resolved. One year later, she presented with intermittent epigastric pain, which she reported having had for several months. Again, a tapeworm was seen on upper gastroduodenal endoscopy, and tapeworm segments were identified on colonoscopy (see video, available with the full text of this article at www.nejm.org). The patient was given praziquantel, and a 20-cm tapeworm passed in her stool. Her symptoms abated. This patient lives in a community where it is customary to eat uncooked pork and pork liver, particularly at festivals, which suggests infection with Taenia solium (the pork tapeworm) rather than T. saginata (the beef tapeworm).

Wen-Shen Liao, M.D.
Ming Jong Bair, M.D.
Mackay Memorial Hospital, Taitung, 950 Taiwan
a4070@ttms.mmh.org.tw

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