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Abstract
Ascariasis is the infestation by the largest intestinal nematode of man, a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. The aim of this research is to analyse the presentation, diagnosis and management of bowel obstruction caused by Ascaris lumbricoides, with special emphasis on the role of conservative management.
This is a single centre, two consultant based 5 year retrospective study of childhood intestinal obstruction due to worms. Diagnosis in the suspected patients was based on history of passage of worms per mouth or rectum and on x-ray and ultrasonography findings. Only the patients of intestinal obstruction with documented evidence of roundworm infestation were included in the study and were followed for one year.
One hundred and three children with intestinal obstruction due to Ascaris lumbricoides were treated in the past five years at our centre. Abdominal pain was the most common presentation seen in 96 children followed by vomiting in 77 children. 20 children had history of vomiting worms and another 43 had history of passing worms in stool. Abdominal tenderness was present in 50 children, 48 had abdominal distension of varying degree, 50 had abdominal mass due to worm bolus, and 16 had or developed abdominal guarding or rigidity. All the children were managed as for acute intestinal obstruction along with hypertonic saline enema. The aim of management was "to starve the worm and hydrate the patient". 87 patients (84.47%) responded favourably and were relieved of the obstruction by the conservative management, 16 children (15.53%) had abdominal guarding or rigidity and underwent emergency exploration.
Roundworm obstruction should be considered in the differential diagnoses of all cases of intestinal obstruction in children. Clinical history and examination along with X-ray and ultrasonography are very helpful for diagnosis of this surgical emergency. Most cases of intestinal obstruction due to Ascaris can be managed conservatively; however emergency surgery is needed in patients with abdominal guarding and rigidity.
... Obstruction usually occurs at the ileocecal valve. Surgical implications of worm infestation are: small bowel obstruction, intussusception and volvulus [7]. Pressure exerted by worm bolus could potentially cause intestinal necrosis and ileal perforation but these disastrous circumstances seldom happen [8]. ...
... A diagnosis of ascariasis obstruction is often achieved with ultrasound alone. Mishra et al. (2008) summarised the ultrasonographic findings of Ascaris obstruction depicted in various studies as multiple elongated, parallel echogenic strips with the absence of acoustic shadow [7]. CT-scan of the abdomen may be ordered at times to exclude perforation, or when there is ambiguity of ultrasound imaging [8]. ...
... A diagnosis of ascariasis obstruction is often achieved with ultrasound alone. Mishra et al. (2008) summarised the ultrasonographic findings of Ascaris obstruction depicted in various studies as multiple elongated, parallel echogenic strips with the absence of acoustic shadow [7]. CT-scan of the abdomen may be ordered at times to exclude perforation, or when there is ambiguity of ultrasound imaging [8]. ...
Ascaris lumbricoides (A. lumbricoides), the soil-transmitted helminth is the most prevalent parasitic infection of the gastrointestinal tract in developing countries. Heavy worm loads mainly due to untreated worm infestations are often associated with increased risk of severe sequelae. We report the first complicated case of A. lumbricoides causing small bowel obstruction in a 9-year-old boy that necessitated surgical intervention on a tropical island in the Indian Ocean, where cases of Ascariasis are rarely encountered.
... About 70% of the children in the African and South East Asian region are infected with AscarisLumbricoides. [5] The incidence is high in children between 2-10 years age group but the peak incidence is seen in 4-6 years age group. [6] The infection is caused by the embryonated eggs which hatch in the intestine where the larvae penetrate the gut wall and through blood supplies can reach lungs and alveoli. They are coughed up by the patients and reingested, after which they reach the intestine and mature into adult worms. ...
... [8] Other manifestations of Ascariasis could be Acute Appendicitis, Meckel's Diverticulum perforation, Intussucception of the intestine, acute pancretitis, cholangitis, liver abscess or acute cholecystitis. [3,4,6] The diagnosis of acute intestinal obstruction secondary to Ascariasis should be suspected in all the patients of acute abdomen with history of passge of worms in vomitus or stools. A plain X-ray of the abdomen will show multiple air fluid levels suggesting obstruction. ...
... Mishra PK et al subjected 103 children with Ascaris induced intestinal obstruction, to conservative management with hypertonic saline enemas, Intravenous (IV) Fluid and Nil per Oral (NPO) regimen. [6] Nearly 85% children responded to conservative treatment but 15% developed signs of peritonitis and had to be operated. Out of 16 patients who underwent surgery, 6 patients had volvulus of small gut with gangrene. ...
Introducation: AscarisLumbricoides is the most common nematode infecting the preschool children throughout the world. The patients are usually asymptomatic or present with mild non specific abdominal symptoms and malnutrition with a low Ascaridial load. The patients having high worm load can present with intestinal obstruction which could sometimes be managed conservatively. Small gut volvulus is a less frequent but potentially dangerous complication of Ascaris infestation having high morbidity and mortality unless quick surgical intervention is done. Case Presentation: We present the case of a 4 year old male child who presented to the Emergency Room with the features of pain abdomen with distension, feculent vomitus, fever and a history of passage of worms in stools. X-ray abdomen showed multiple air fluid levels suggestive of Acute Intestinal Obstruction. The patient was subjected to exploratory laparotomy where the small gut was found to be full of Ascarides. There was a gangrenous ileal segment due to small gut volvulus. The gangrenous segment was resected and an end to endileo-ileal anastomosis was performed after evacuating all the worms. In the post operative period patient had an episode of bilious vomiting which contained mature worms. Patient was managed conservatively and was discharged home on 9 th post operative day, after antihelminthic treatment was given to him and his whole family. Conclusions: Intestinal obstruction is the most common complication of Ascariasis. Small gut volvulus is a rare presentation of this worm infestation which requires urgent surgery or else there is a risk of poor patient outcome. Post operative antihelminthic therapy of the whole family, repeated at frequent intervals is necessary since there is high incidence of re-infection. Public health measures like practise of proper hand hygiene, proper sanitation and management of the human waste are essential for prevention of worm infestation in the society.
... Intestinal obstruction is the commonest surgical complication of ascariasis, especially in children. [1][2][3][4][5][6][7][8][9][10][11][12][13] In Kashmir ascariasis related complications account for 50 to 60 percent of admission in pediatric surgical emergency. [3][4][5][6][7][8][9] Most of the worm obstructions are managed conservatively with close monitoring for the development of severe complications. ...
... [1][2][3][4][5][6][7][8][9][10][11][12][13] In Kashmir ascariasis related complications account for 50 to 60 percent of admission in pediatric surgical emergency. [3][4][5][6][7][8][9] Most of the worm obstructions are managed conservatively with close monitoring for the development of severe complications. The conservative management in uncomplicated worm obstruction includes restricting oral feeding, nasogastric suction, repeated enemas, fluid resuscitation, electrolyte replacement, antibiotic coverage and analgesics. ...
... 11 Ascariasis can cause serious intra-abdominal complications such as intestinal obstruction, biliary obstruction, cholangiohepatitis, liver abscess, pancreatitis, acute appendicitis, intestinal perforation, and granulomatous peritonitis. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Luminal obstruction is the most common complication of round worm infestation and more so in children attributable the narrower intestinal lumen. 7,10 The obstruction is caused by an entanglement of worm boluses and spasmodic contraction of the small bowel on to a mass of worms with effectual obstruction at the ileo-cecal valve, augmented by inflammation and matting of loops of the bowel at the site occupied by worms. ...
Introduction: Small bowel obstruction is the most common complication of roundworm (Ascaris lumbricoides) infestation commonly affecting the pediatric age group. This is a prospective randomised study comparing results of early de-worming in children with roundworm induced small bowel obstruction with that of delayed deworming during the course of admission.
... As the eggs are very sticky, they readily adhere to raw fruits and vegetables, which are washed with contaminated water or fertilized withcontaminated night soil. They may also circulate inhousehold dust and air where they are inhaled or swallowed [14] .Gastrointestinal complications of ascariasis include luminal occlusion, volvulus, perforations, appendicitis and intussusception [9,15] .Ascaris worm bolus can initiate intraluminal obstruction near the ileo-ceacal valve and aggravates spasticity of distal ileum by combined action of endo toxins of worms and host inflammatory response [9,11,15] , can also act as lead point for intussusceptions and pivot for volvulus [9,11,16] . In Although most series report intestinal luminal occlusion as the most common presentation which ranges from 50% to 65% [15] , in our study the presentation came out to be 70% of the total cases, and it is probably because the cases which were managed conservatively were not taken into consideration and only those cases which required a surgical intervention were included in the study. ...
... As the eggs are very sticky, they readily adhere to raw fruits and vegetables, which are washed with contaminated water or fertilized withcontaminated night soil. They may also circulate inhousehold dust and air where they are inhaled or swallowed [14] .Gastrointestinal complications of ascariasis include luminal occlusion, volvulus, perforations, appendicitis and intussusception [9,15] .Ascaris worm bolus can initiate intraluminal obstruction near the ileo-ceacal valve and aggravates spasticity of distal ileum by combined action of endo toxins of worms and host inflammatory response [9,11,15] , can also act as lead point for intussusceptions and pivot for volvulus [9,11,16] . In Although most series report intestinal luminal occlusion as the most common presentation which ranges from 50% to 65% [15] , in our study the presentation came out to be 70% of the total cases, and it is probably because the cases which were managed conservatively were not taken into consideration and only those cases which required a surgical intervention were included in the study. ...
... As the eggs are very sticky, they readily adhere to raw fruits and vegetables, which are washed with contaminated water or fertilized withcontaminated night soil. They may also circulate inhousehold dust and air where they are inhaled or swallowed [14] .Gastrointestinal complications of ascariasis include luminal occlusion, volvulus, perforations, appendicitis and intussusception [9,15] .Ascaris worm bolus can initiate intraluminal obstruction near the ileo-ceacal valve and aggravates spasticity of distal ileum by combined action of endo toxins of worms and host inflammatory response [9,11,15] , can also act as lead point for intussusceptions and pivot for volvulus [9,11,16] . In Although most series report intestinal luminal occlusion as the most common presentation which ranges from 50% to 65% [15] , in our study the presentation came out to be 70% of the total cases, and it is probably because the cases which were managed conservatively were not taken into consideration and only those cases which required a surgical intervention were included in the study. ...
surgical complications of pediatric ascariasis
... The most common symptom our patients presented with was abdominal pain. This is supported by the report of previous workers [11,15,16] [3,[17][18][19][20]. Abdominal distension was observed by Pathak et al as the most common presenting symptom [21]. ...
... These are patients who had intussusception and presented early to the hospital. However, Ooko et al and Mishra et al reported high number of their patients treated non-operatively [3,11]. The disease process involved and the time of presentation to the hospital may explain this difference in treatments given to the patients. ...
... Surgical site infection was the most common complication in our patients. This finding is consistently observed in many other reports too [6,8,11,16,20]. The mortality rate in the current study is in agreement with that of other studies of its nature [3,19]. ...
Background: Paediatric intestinal obstruction is a common surgical emergency and is associated with lots of morbidity and mortality especially in developing countries. Paediatric intestinal obstruction differs from adult intestinal obstruction in terms of aetiology, presentation, management and outcome. This study reports the demography, diagnosis, management and outcome of paediatric intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of paediatric patients who presented with intestinal obstruction to the paediatric surgical unit of Enugu State University Teaching Hospital (ESUTH) Enugu, South East Nigeria. Children above one month of age but below 15 years, who presented with symptoms and signs of intestinal obstruction, were recruited for the study. Intestinal obstruction in neonates was excluded from this study. The study period was for one year, from January 1 st 2018 to December 31 st 2018. Result: During the period of the study 45 cases, 30 (66.7%) males and 15 (33.3%) females were managed. The mean age of the patients was 52.2 months. Abdominal pain was the most common presenting symptom and intussusception was the most common cause of intestinal obstruction. Forty two patients (93.3%) did well and were discharged. Two patients (4.4%) died while one patient (2.2%) was discharged against medical advice. Conclusion: Intussusception was the most common cause of intestinal obstruction in the current study. The mortality of 4.4% recorded in this study can be improved upon.
... Surgical complications are common in patient with a high worm load and include mechanical small bowel obstruction, gastrointestinal haemorrhage, gastrointestinal perforation, obstructive jaundice, pancreatitis, and appendicitis [2][3][4][5][6][7][8]. Intestinal obstruction is the most common complication and commonly occurs near the ileal-caecal valve as result of a bolus of worm obstructing the bowel lumen [3,4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. ...
... Plain radiographs of abdomen show radiolucent areas, cigar bundle appearance, "whirlpool" sign, pneumoperitoneum in a case of perforation and multiple air fluid levels in case of heavy worm infestation [5,6,22]. Ultrasound findings suggestive of ascariasis include the following:-(a) a thick echogenic strip with a central anechoic tube; (b) multiple long, linear, parallel echogenic strips without acoustic shadowing in longitudinal (railway track) and transverse (bull's eye) views [20][21][22]. Challenging operative findings include perforation with faecal contamination, gangrenous bowel and heavy worm infestation. These were the challenges we encountered in a haemodynamically unstable 17 year old female patient we successfully managed. ...
... This results in delay in diagnosis and increase in morbidity as was the case with our patient.More often surgeons carry out emergency abdominal surgery and only make the definitive diagnosis at laparotomy, as in our case. When available imaging studies can accurately diagnose intestinal ascariasis[5,6,[20][21][22]. It is particularly important to identify worms on plain xrays as this can avoid unnecessary laparotomy for partial obstructionthorough timely administration of medical treatment. ...
Oftentimes general surgeons working in poorly resourced communities carry out emergency abdominal surgery in patients with acute abdomen with no definitive preoperative diagnosis. The definitive diagnosis is made at laparotomy. Perforated small bowel obstruction secondary to heavy Infestation with Ascaris Lumbricoides brings a number of intraoperative challenges requiring correct intraoperative surgical management decisions. We present a case of a 17 year-old patient who was admitted with a diagnosis of small bowel obstruction who at laparotomy was found to have perforated gangrenous small bowel volvulus with heavy work load visible through the bowel wall. Because of faecal peritoneal contamination and haemo-dynamic instability she underwent a two staged procedure with good outcome.
... 7 The various USG appearances of ascaris lumbricoides have been described as thick echogenic strip with central anechoic tube, multiple linear or curvilinear echogenic strips without acoustic shadowing, a "winding highway" or "parallel lines"; "railway track" sign; "3-line "or "4line" sign on longitudinal scan and a "doughnut" or "target" sign and "bull's eye" appearances on transverse scan. 8 Contrast studies, CT or MRI may be useful but are not essential, especially in acute emergencies. ...
... Even in cases of intestinal obstruction, conservative treatment with fluid resuscitation and hypertonic saline enema have been shown to be relieving in 50-85% of the cases. 8,9 Surgical intervention was reserved for cases developing abdominal guarding or rigidity in a 5year retrospective study. 8 The procedure of choice should be decided on-table on an individual basis, depending upon the laparotomy findings. ...
... 8,9 Surgical intervention was reserved for cases developing abdominal guarding or rigidity in a 5year retrospective study. 8 The procedure of choice should be decided on-table on an individual basis, depending upon the laparotomy findings. Detorsion of the volvulus with enterotomy at the point of maximum worm burden to extract as many roundworms should be done, provided the viability of the intestinal wall has been ascertained beforehand. ...
Ascariasis infestation is a common helminthic disease in developing countries with a wide spectrum of clinical presentations, one of which can be acute abdomen. Small bowel volvulus is a serious life-threatening emergency. The aetiology may be primary as is often seen in Africa and Asia, while in Western countries other predisposing conditions usually initiate the volvulus. Ascariasis is highly prevalent in India and so, a myriad of different presentations is quite obvious. Here the authors have reported a case of a 6year old boy presenting with features of acute intestinal obstruction-central abdominal pain, repeated vomiting and abdominal distension. After evaluation with abdominal radiography and ultrasonography, exploratory laparotomy was planned. A secondary ileal volvulus compact with worms of ascaris lumbricoides was found. Resection of non-viable ileum was done after evacuation of worms by enterotomy followed by primary anastomosis. Prompt clinical diagnosis, a high index of suspicion for complications and early surgical intervention are critical in minimizing morbidity in cases of Intestinal Ascariasis.
... Radiology: Diagnostic evaluation of a child with intestinal obstruction due to ascariasis may show radiolucent shadow in the form of Bcigar bundle appearance^or Bwhirlpool effectd ue to contrast of mass of worms against intestinal air on plain radiograph [18]. Direct visualization of worms is possible on ultrasound abdomen. ...
... Direct visualization of worms is possible on ultrasound abdomen. The coiled body of Ascaris worm in biliary tract gives a classic end on image on ultrasound called Bbull's eye sign^or Bdouble tubes sign^ [18]. ...
... Additional use of hypertonic saline enema may facilitate the disentanglement of worms. Current evidence does not favor use of anthelminthic drugs as their use may lead to risk of intussusception, volvolus, necrosis or even perforation [18]. ...
Worm infections continue to be among the most common diseases affecting children from low and middle income countries. Major worm infections of public health importance include Ascariasis, Trichuriasis, Hookworm, and Enterobiasis, which are transmitted through contaminated soil. In India, combined prevalence rates of worm infestation as per pooled data of 127 surveys is over 20%. Although most helminthic infections are mild and are often asymptomatic, but moderate to heavy worm infestations are generally associated with growth faltering, nutritional compromise, anemia and suboptimal academic performance among children from endemic regions. Migration of larval or adult worms also underpins pulmonary and gastrointestinal morbidity in affected children. Some of the distinctive life cycle and clinical features of various worms are discussed in the review. The gold standard diagnostic technique for evaluation of worm infestation includes stool microscopy for direct egg detection and species identification. Most of the community based surveys for detecting soil transmitted helminths (STH) use Kato-Katz technique. The drug armamentarium against worm infestation has evolved tremendously in last three to four decades with the availability of more efficacious and broad spectrum anthelminthics. The key strategies of a multi-component integrated management of worm infestation include individualized treatment, community management (mass drug administration) as well as preventive measures. Finally, barriers to diagnosis, treatment and prevention of worm infestations need to be identified and aggressively managed at individual, family and societal levels so that WHO’s 75% coverage target can be achieved to eliminate soil transmitted helminthiasis in children by 2020.
... A transmissão do Al ocorre através da ingesta de alimentos e água contaminados, no contato com material subungueal ou com o solo contaminado, seja através do hábito de levar as mãos e objetos à boca, seja com a prática da geofagia e, raramente, através da inalação ou deglutição de ovos presentes em secreção respiratória contaminada (MELO et al., 2004;KHAN et al., 2007;MISHRA et al., 2008 CASTRILLÓN, 2007;MISHRA et al., 2008;MONTAÑO;BARE, 2011;OJHA et al., 2014). ...
... A transmissão do Al ocorre através da ingesta de alimentos e água contaminados, no contato com material subungueal ou com o solo contaminado, seja através do hábito de levar as mãos e objetos à boca, seja com a prática da geofagia e, raramente, através da inalação ou deglutição de ovos presentes em secreção respiratória contaminada (MELO et al., 2004;KHAN et al., 2007;MISHRA et al., 2008 CASTRILLÓN, 2007;MISHRA et al., 2008;MONTAÑO;BARE, 2011;OJHA et al., 2014). ...
... Na maioria das vezes a ascaridíase é assintomática. Quando presentes, os sintomas decorrem de três status principais do parasito no hospedeiro: 1) migração pulmonar na fase larval durante o ciclo de Loss, quando causam uma pneumonite transitória por hipersensibilidade imediata e auto-limitada que se resolve em 2 semanas -a Síndrome de Löeffler; 2) obstrução intestinal devido a um elevado número de vermes adultos e 3) migração errática dos áscaris adultos (DORIA; ROCHA, 2000;MELO et al., 2004;WANI et al., 2006;MISHRA et al., 2008;CASTILLO;GONZÁLEZ, 2011). ...
A ascaridíase é endêmica em países em desenvolvimento e está relacionada a baixas condições socioeconômicas. É a helmintíase mais prevalente, principalmente nos pacientes pediátricos, sendo assintomática na maioria dos casos. Na infestação maciça, pode evoluir com complicações tais como obstrução intestinal e invasão das vias biliares. Radiografia abdominal e ultrassonografia são os principais exames médicos diagnósticos. Inicialmente o tratamento é conservador, no entanto pode se tornar cirúrgico. O objetivo desse trabalho é analisar a apresentação clínica, o diagnóstico e o tratamento de infestação maciça por Ascaris lumbricoides através do relato de um caso de ascaridíase maciça em criança de Macapá – AP, que evoluiu com suboclusão intestinal e invasão da vesícula e das vias biliares. Os dados foram coletados do prontuário médico e foi feita revisão da literatura nos principais acervos médicos digitais no período de 2000 a 2014. Uma vez conhecendo suas formas de apresentação e complicações, os médicos estarão aptos a manejá-la apropriadamente, contribuindo para diminuir sua morbimortalidade nas regiões endêmicas.
Palavras-chave: Ascaridíase maciça, migração errática, suboclusão intestinal, invasão das vias biliares, invasão da vesícula biliar.
DOI: http://dx.doi.org/10.18561/2179-5746/biotaamazonia.v4n4p102-107
... lumbricoides) is one of the largest of the parasites that infest the human bowel, common in regions with poor sanitation, in the tropics and subtropics. [1] Common acute surgical abdomen caused by Ascaris infestation include small intestinal obstruction, volvulus, intussusception and perforation usually involving the appendix or Meckels diverticulum, ileum, and rarely through areas of pre-existing bowel pathology and biliary ascariasis. [1,2] Radiologic investigations are helpful in the managements of A. lumbricoides. ...
... [1] Common acute surgical abdomen caused by Ascaris infestation include small intestinal obstruction, volvulus, intussusception and perforation usually involving the appendix or Meckels diverticulum, ileum, and rarely through areas of pre-existing bowel pathology and biliary ascariasis. [1,2] Radiologic investigations are helpful in the managements of A. lumbricoides. [1][2][3] We present our experience of surgical complications of A. lumbricoides in 16 children. ...
... [1,2] Radiologic investigations are helpful in the managements of A. lumbricoides. [1][2][3] We present our experience of surgical complications of A. lumbricoides in 16 children. ...
To report the surgical complications of Ascaris lumbricoides infestation in children.
This is a retrospective study and cases of intestinal ascariasis managed conservatively were excluded.
Sixteen children presented with Ascariasis sequelae, which included ileal volvulus (n=5), perforations (n=4), intussusception (n=1), biliary ascariasis (n-1) and impacted multiple worm boluses (n=5). Plain abdominal radiographs showed pneumoperitoneum (3), cigar bundle appearance (3) and multiple air and fluid levels (13). Sonography showed floating worms with free fluid (2), sluggish peristalsis and moderate free fluid (7) and intestinal worm bolus (11). The surgical procedures included milking of worms (in all), bowel resection (6), closure of perforation (3) and manual reduction of intussusception (1). Biliary ascariasis was managed conservatively and the progress monitored with sonography. There were 3 deaths all of whom had intestinal volvulus, bowel necrosis and toxemia.
Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Early surgical intervention in those with worm bolus, peritonism, and volvulus may salvage bowel and reduce mortality.
... The disease is present especially in rural areas of tropical and subtropical countries with poor hygiene and socioeconomic conditions. The global frequency of ascariasis depends on a country's regional, climatic, economic, and cultural conditions [1][2][3]. Although it occurs in all ages, preschool and school children are predominantly affected [3,4]. ...
... The global frequency of ascariasis depends on a country's regional, climatic, economic, and cultural conditions [1][2][3]. Although it occurs in all ages, preschool and school children are predominantly affected [3,4]. ...
... Ascariasis remains a prevalent parasitic infection in the developing countries of Asia, Africa, and Latin America, where levels of sanitation, personal hygiene, and education are low [1][2][3]. It is most common in children between 2 and 10 years of age, and the prevalence decreases beyond the age of 15 years [3,4]. ...
Ascariasis is a helminthic infection of global distribution, and intestinal obstruction is its most common gastrointestinal
complication. This is a case of a 7-year-old boy admitted to Pediatric Surgery because of intestinal obstruction caused by
ascariasis. On admission, the patient presented with colicky abdominal pain, bile-stained vomiting and meteorism. On physical
examination, the patient was thin, pale, and dehydrated. An abdominal examination showed distention and diffuse tenderness.
After admission, the patient had fecal vomiting and expulsion of worms through the mouth. Laboratory-test results showed leucocytosis,
eosinophilia, hypoalbuminaemia, and hypochloremia. Abdominal radiographs and ultrasound studies were indicative of small-bowel
obstruction due to roundworms, which led to the performance of an exploratory laparotomy. On bowel exploration, an intraluminal
mass, 10 by 6 cm in diameter, consisting of roundworms in the middle third of the ileum was found. A longitudinal enterotomy
was performed, and the worms were meticulously extracted manually. Postoperatively, broad-spectrum antibiotics and antihelminthic
drugs were administered. Our case of intestinal obstruction caused by ascariasis is the first to be reported in Serbia, according
to the Serbian literature.
KeywordsAscariasis–Intestinal obstruction–Enterotomy
... Gastrointestinal (GI) tract infestation with A. lumbricoides is a worldwide phenomenon, it is estimated that one billion or more of the world's population, mostly in the third world countries, are infested with the worm [1]. Although a vast majority of cases are asymptomatic, infected patients may present with a potentially severe variety of GI and rarely pulmonary or neurological disturbances [2][3][4]. The clinical presentation sometimes mimics surgical conditions, making the diagnosis difficult for junior physicians unfamiliar with this infestation. ...
... Fortunately, the patient vomited the worms which solved the dilemma in a short period. Adult worms usually reside in the intestine without causing dangerous complications, however, they may move to other parts of the GI tract when the environment becomes inappropriate for their survival [2]. In our case, constipation most likely causes the worm to migrate to the stomach, irritating it, and eventually resulting in the worm being expelled through the patient's mouth. ...
Ascaris lumbricoides infestation is a worldwide common soil-transmitted helminths infection mainly affecting children in the developing and low socioeconomic status countries where the transmission is by contamination of soil by human feces or use of untreated feces as fertilizer [1]. However, it is rare in Qatar, and most cases have been reported among non-Qatari residents who visited their home country while on vacation. In this report, we presented a case of A. lumbricoidesinfection in a preschool child who arrived in Qatar after a trip to the Gaza strip and expelled three adult A. lumbricoides worms from the mouth.
... Although rare, perforation peritonitis is a known complication of ascariasis. In most of these cases, co-existing bowel pathologies like typhoid, amoebiasis, Meckel's diverticulitis, ischemic necrosis due to volvulus, and trauma play a synergistic role in causing the perforation [2,3]. It has been postulated that the Ascaris produces a lytic secretion that helps in the nibbling effect of the Ascaris head and ischemia from pressure by the mass of worms in the small intestine leads to perforation of the normal bowel wall [1,2]. ...
... In most of these cases, co-existing bowel pathologies like typhoid, amoebiasis, Meckel's diverticulitis, ischemic necrosis due to volvulus, and trauma play a synergistic role in causing the perforation [2,3]. It has been postulated that the Ascaris produces a lytic secretion that helps in the nibbling effect of the Ascaris head and ischemia from pressure by the mass of worms in the small intestine leads to perforation of the normal bowel wall [1,2]. ...
Ascaris migration from the intestine into the peritoneal cavity is rarely seen and the usual presentation is the acute abdomen. Our case report is of a young male who got admitted after a roadside accident with polytrauma including blunt trauma abdomen. When the patient was taken up for exploratory laparotomy, a freely lying tubular structure was noticed in the pelvis and small intestinal perforation. On inspection, it turned out to be an Ascaris worm. This is a case report of a rare presentation of Ascaris lumbricoides with jejunal perforation following blunt trauma. This blunt trauma could have been the cause of an intestinal perforation resulting from a concealed presence of an impending Ascaris perforation.
... Acute abdomen is caused due to [ 1 ] gastrointestinal diseases such as intestinal obstruction, perforation peritonitis and acute appendicitis. The causes of obstruction in [2] children are anorectal malformations, intussusception, Meckel's diverticulum, abdominal kochs, congenital band obstructions, Hirschprung's disease, ascariasis, post operative bands and adhesions, etc. [2], [3], [4] Intussusception remains a common cause of bowel obstruction in young children and results in signicant morbidity and mortality. [2], [3], [5] Typhoid ileal perforation is still prevalent in developing country like India and is associated with high morbidity and mortality in children. ...
... However emergency surgery like enterotomy, milking of worm in large intestine and resection and anastomosis is needed in patients with features of gangrene and perforation. we had 2 cases of worm obstruction in whom [4], [12] enterotomy was done for removal of bunch of worms. ...
INTRODUCTION: Acute abdomen can be defined as “syndrome included by wide variety of pathological conditions that require emergent medical or more often surgical management.” Acute abdomen is caused due to gastrointestinal diseases such as intestinal obstruction and perforation peritonitis. AIM: The aim of our study was to observe the common cause in paediatric age group undergoing emergency laprotomy in our institutions. MATERIAL AND METHODS:This prospective study included 77children aged below or equal to 15years, underwent emergency laprotomy for acute intestinal conditions between January 2019 to December 2019 in RIMS,RANCHI. We excluded neonates ,patients of jejunoileal colonic atresia and stenosis, anorectal malformation(ARM), congenital pouch colon, neonatal necrotizing enterocolitis(NEC), hirschprung’s disease, gastrointestinal tumor. RESULTS: Total of 77 laprotomies were performed in emergency in children below or equal to 15 years age,59(76.62% ) were boys and 18(23.37% )were girls with male:female ratio of 3.2:1. 36(46.75%) cases were done for acute intestinal obstruction and 41(53.24%) cases were done for perforation peritonitis.20(25.97%)emergency laprotomy was performed in the age group 1-5 years and 57(74.02% ) were performed in the age group 5-15 years. Causes in order of frequency for intestinal obstruction were intussusceptions, post operative band/adhesion, abdominal tb obstruction, meckel’s diverticulum and worm obstruction. Causes in order of frequency for perforation peritonitis were typhoid, abdominal tb, appendicular perforation and abdominal trauma. CONCLUSION: In our study maximum emergency laprotomy was performed in male patients with male:female ratio of 3.2:1. Perforation peritonitis was more common than acute intestinal obstruction. 5-15 year age group were more commonly affected. Typhoid ileal perforation was the most common cause for emergency laprotomy followed by intussusception.
... Although Ascariasis occurs at all ages, it is most common in children 2 [10] to 10 years old and prevalence decreases over the age of 15 years. Radiologic investigations are helpful in the managements of A. [11][12][13] lumbricoides. ...
... Gastrointestinal sequelae of ascariasis include luminal occlusion, [11,14] volvulus, perforations, appendicitis and intussusception. Our series also report a similar trend of acute surgical problems associated with ascariasis. ...
... [6,16,17] In this study, strangulated hernia was the second cause of AMIO and strangulated umbilical hernias are most common (25.64% of cases); worldwide, strangulated inguinal hernias were most reported. [3,5] Parasitic aetiologies of AMIO, especially roundworms, which predominate in some series [5,19] have not been recorded in our study. In Niger, the common use and promotion of antihelminthic agents at community level for several years could explain this situation. ...
... It's a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. [3,19] Obstructed hernias ranked fourth in the list. ...
Background:
To describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (Niger).
Materials and methods:
This was a cross-sectional study on a period to January 2013-June 2015. The database included all children under 15 years of age with a surgical diagnosis of mechanical intestinal obstruction. P < 0.05 was considered statistically significant for analysis.
Results:
AMIOs represent 21.78% (n = 78) of child digestive surgical emergencies (n = 358). Median age was 12 months (range: 1 day-15 years). Fifteen (19.23%) were neonates and sixty children (76.92%) had ≤60 months. The sex ratio (male/female) was 2.8. The mean time from onset to presentation was 39.96 ± 36.22 h. Intussusception and strangulated hernias were the main causes of AMIO with, respectively, 43.59% (n = 34) and 29.48% (n = 23). Anorectal malformations represent 17.95% (n = 14) of cases of AMIO. Intestinal resection was made in 22.08% and colostomy in 19.23% of patients. The average length of hospital stay was 6.44 ± 4.30 days. The post-operative complications were recorded in 26 patients (33.33%), mostly surgical site infections. Overall mortality of AMIO was 15.38% (n = 12). It was higher in the neonates (33.33%) (P = 0.032). Deaths were associated with delay of admission (P = 0.0005) and waiting time for surgery (P = 0.019).
Conclusion:
Intussusception and strangulated hernia are the most common cause of AMIO in children. Diagnostic and therapeutic delays, lack of paediatric intensive care and post-operative complications are prognostic factors.
... Intestinal obstruction is an acute presentation that has been observed in a number of cases where there is an increased worm burden that may partially or completely block the intestinal lumen. 1,2 We present a case that proved difficult to diagnose as the child's symptoms of subacute intestinal obstruction did not pair up with the radiological results, forcing us to take unusual measures for diagnosis. A 3-year-4-month-old child presented to the emergency department with the complaints of greenish vomiting and abdominal pain for 3 days. ...
... AL migration may cause serious complications such as pulmonary ascariasis, pancreatitis, liver abscesses, cholecystitis, volvuli, intussusception, and intestinal obstruction. [1][2][3][4] Diagnosis with clinical symptoms, hematological investigations, and biochemical profile is usually inconclusive. Testing the stool for ova is one of the initial tests that are done which aid in establishing a diagnosis. ...
Ascariasis is a common infestation in developing countries where there is poor hygiene. A majority of the cases are asymptomatic, with a few cases presenting with mild abdominal pain and nutritional deficiencies in the long term. Here we present a case of a young boy who presented as a diagnostic dilemma, with signs of acute intestinal obstruction without any supporting radiological evidence. A barium study revealed the presence of low-burden Ascaris infestation that was managed medically.
... Roundworm related intestinal obstruction is more common in children because of the smaller diameter of the lumen of the bowel [2]. Obstruction due to Ascariasis commonly occurs at the terminal ileum. ...
... Obstruction due to Ascariasis commonly occurs at the terminal ileum. Usually Ultrasonography indicates the presence of round worms [2] but was not seen in our case. Death due to ascaris is very rare. ...
... Stressful situations like fever, diarrhea, anesthesia, etc. are well-known triggers for worm migration. 16 The migration can occur into the common bile duct (most common) or the gallbladder or the intrahepatic ducts. 17 Sphincterotomy, sphincteroplasty, or bilio-enteric anastomosis reduces the resistance, making migration easier. ...
Parasitic diseases continue to affect millions of people in the endemic areas causing morbidity as well as affecting the quality of life. The visitors to these endemic areas get infected with these parasites and present a confusing picture to the physicians in their native area. Prolonged exposure to some of these parasites like is a well-known risk factor for malignancy. However, most of these diseases are easily curable. This review article provides a brief description of a few parasitoses like amebiasis, ascariasis, clonorchiasis, opisthorchiasis, and fascioliasis. Their causative agents, disease-causing mechanisms in the host, clinical features, specific radiologic findings, and immunodiagnostic tests are discussed. The medical and surgical aspects of treating these parasitoses are also summarized.
... Ascariasis is an intestinal nematode caused by Ascaris lumbricoides (roundworm), affecting as many as 1.5 billion people worldwide; it is a significant cause of morbidity and mortality in various parts of the world [1]. It is quite common in tropical and subtropical regions, with the highest prevalence noted among children aged 2-10 years [2][3]. The mode of transmission is the fecal-oral route and risk factors include poor personal hygiene and sanitation, warm climate, and humidity [4]. ...
Ascaris lumbricoides is a fairly common intestinal nematode affecting children worldwide, leading to major medical and surgical complications. Although most of the cases are asymptomatic, heavy infestation causes various acute abdominal complications. Ascaris-induced intestinal intussusception is one of the rare presentations.
We report a case of a 13-year-old boy with Ascaris lumbricoides infestation presenting with ileocolic intussusception. The patient presented to the emergency unit with colicky abdominal pain, vomiting, and constipation for two days. He was sick-looking and dehydrated. Further examination revealed diffuse abdominal distension with tenderness, guarding, and palpable mass in the right lower quadrant. Ultrasonography showed long-segment ileocolic intussusception with several worms in the intestinal lumen and adjacent mesenteric lymphadenopathy. An exploratory laparotomy was performed, which revealed ileocolic intussusception. The telescopic loop of the ileum was found to be gangrenous and was resected, and a loop ileostomy was performed. The patient was discharged on the seventh day postoperatively without any complications.
Physicians in tropical and subtropical countries should consider this condition in the differential diagnosis when they encounter similar presentations in their clinical practice. Sonography is a non-invasive, easy-to-use, and widely available imaging modality that can be employed to diagnose entrapped Ascaris in cases presenting with acute gastrointestinal complications. Early diagnosis and prompt surgical intervention can prevent bowel ischemia/gangrene and significantly reduce morbidity and mortality associated with such cases.
... Among the cases of intussusception, 24/76, the commonest underlying aetiology was enlarged mesenteric lymph nodes, while the commonest type recognized on surgical exploration was ileocolic/ileocecocolic. Compared to the previous studies, worms' infestation, ascariasis, remained the third leading cause of SBO, found among 11/76 no of cases which was quite high compared to the previous studies. 16,17,18 Abdominal Tuberculosis was confirmed in three of our cases, with the affected cases showing adhesions obstructing the small bowel loops. ...
Objective: To analyze the diagnostic accuracy of ultrasound in small bowel obstruction in the paediatric population and compare it with surgical findings. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan from Jun 2018 to Jun 2019. Methodology: This study enrolled 84 paediatric small bowel obstruction cases who underwent exploratory laparotomy at the Pakistan institute of medical sciences from Jun 2018 to Jun 2019. The clinically suspected cases of small bowel obstruction were referred by paediatric surgery to the Radiology department, where an ultrasound abdomen was performed by a senior resident, exclusively targeting the bowel. The clinical, sonological, and per-operative findings were recorded on a proforma. Results: The mean age in our study was 3.5±2.7 years. A male gender predominance was noted. The most consistent greyscale feature favouring bowel obstruction was dilated bowel loops, found among 98.7% (76 out of 77) of surgically confirmed cases of bowel obstruction. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasound were 98.7%, 71.4%, 97.4%, 83.4% and 94.6% respectively. The sonological cause of obstruction was readily demonstrated among 51 (67%) out of 76 true positive cases. The most common site of obstruction was the distal ileum, with intussusception being the leading cause found among 32% of true positive cases. Conclusion: The overall diagnostic accuracy of ultrasound in revealing small bowel obstruction is high among the paediatric population.
... Worms may be detected in the vomitus. Volvulus, ileocecal intussusception, gangrene, and intestinal perforation are all possible complications [5]. Acute appendicitis may occur due to the occlusion of the appendiceal lumen by adult Ascaris worms or may result from the secondary infection of Ascaris eggs [6]. ...
Introduction and importance
Ascaris lumbricoides is a parasitic roundworm that spread through feces-oral routes and is endemic in many nations with poor sanitation.
Case presentation
We present a case of a 6-year-old boy who arrived in the emergency room with abdominal pain, constipation, and vomiting. Physical examination revealed abdominal distension, absence of bowel sounds, and abdominal tenderness. Abdominal radiographs, ultrasonography, and computed tomography established the diagnosis of intestinal obstruction by A. lumbricoides with associated acute appendicitis and surgical approach scheduled. A massive intraluminal nematode from the jejunum to the ileocecal valve was observed during an exploratory laparotomy. An ileal enterotomy was performed and the worms were removed. The patient was discharged without incident on the 12th day.
Clinical discussion
Ascariasis is the most common helminthic infection worldwide; reaching peak prevalence in children aged 2 to 10. The disease is prevalent in children with environmental and socioeconomic risk factors, causing serious problems such as intestinal obstruction (IO), volvulus, intussusception, and intestinal necrosis.
Conclusion
Ascaris lumbricoid is very prevalent in developing countries and should be kept in mind in preschool children with symptoms of sudden acute intestinal obstruction. The diagnosis of intestinal ascariasis can usually be made with plain radiography, barium examinations, and ultrasonography of the abdomen. Other modalities, such as CT, can also be used. Medical treatment of Ascaris infestation is usually successful; however, bowel obstruction may require surgery.
... Six Gastro Intestinal (GI) nematodes are of great importance, have simple direct life cycle without the involvement of animal as reserviour of infection, among them is A, lumbricoides. Ascariasis is more prevalent in developing countries with poor sanitation and in tropical areas, where the eggs survival prolongs in the environment.A.lumbricoides is one of the largest parasites, infested human bowel and is more common in areas with poor "Socioeconomic status (SES) in tropical and subtropical areas (Mishra et al., 2008).Eggs of A.lumbricoides are sticky, so adhere to food utensils, handles of doors, commode seats, under finger nails, raw fruits and vegetables, can also contaminate drinking water and might be present in household dust and air a permanent risk for children (O'Lorcain and Holland, 2000).Adult worm lives in small intestine / large intestine of man, adult female lays about 200,000 eggs / day those Protected are shed outside via faeces into soil, again the cycle is repeated (Walker et al., 2011), from where they are transmitted to water, vegetables, food, seats of commodes, handles of doors and in air by the insects like house flies and cockroaches (Maipanich et al., 2008).Freshly passed eggs are not infective, at 22 0 C -23 0 C and moisture in soil enhances development. it is viable for 3 years under these suitable conditions in soil, ponds and sewage water. ...
... 2 Bowel perforation is thought to follow ischemia from pressure by the mass of worms in the ileum. 1 Efem has however postulated that except in confined spaces like the appendix, Meckel's diverticulum and the biliary tree, the intestine is capable of immense dilatation so as to accommodate up to 5000 worms without symptoms. 4 Injury to the intra-abdominal structures is primarily by either compression forces or deceleration forces. ...
... Significant increases in fertility are observed in infected women (7). The rate of complications secondary to ascariasis ranges from 11-67%, with intestinal and biliary tract obstruction representing the most common serious sequelae, estimated 730,000 cases of bowel obstruction annually, 11,000 of which are fatal (8). In one series of pregnant patients in Bangladesh, biliary ascariasis was responsible for a plurality (28%) of non-obstetric etiologies of acute abdomen (9). ...
... The disease is present especially in rural areas of tropical and subtropical countries with poor hygiene and socioeconomic conditions. The global frequency of Ascariasis depends on a country's regional, climatic, economic, and cultural conditions (Mishra et al., 2008). A.lumbricoides infection occurs in all age groups but more commonly in preschool children (Steinberg et al.,2003). ...
Ascaris lumbricoides is one of the most well-known helminthic parasites affecting humans, and Ascariasis remains common with > 1.2 billion infections globally. In 2010, an estimated of 819 million people globally have been infested with A. lumbricoides, constituting the most common infection among the other soil-transmitted
helminthes. Above all, significant disability has been reported with A. lumbricoides, amounting towards 1.10 million years lived with disability (YLDs). Aim of this study is to give awareness regarding complication associated with Ascariasis lumbricoides because helminthic infestation is easily overlooked, the diagnosis of Ascariasis should be considered in patients who live in endemic areas and treated timely to prevent severe
complications. Ascariasis generally occurs through hand-to-mouth ingestion of agricultural products or food contaminated with parasite eggs. Poor sanitation and inadequate sewage disposal play a key role in the maintenance and propagation of Ascariasis.
... 9 Conservative management of ascaridial intestinal obstruction using nasogastric decompression, hypertonic saline enema, and supportive measures can be tried in the absence of abdominal guarding or rigidity. 10 In a 5-year study by Mishra et al., 103 children with ascaridial intestinal obstruction were managed conservatively with hypertonic saline enema and intravenous fluid resuscitation. The aim of this treatment was to starve the worm and hydrate the patient. ...
Ascariasis is a common worm infestation in developing and under-developed countries. It is caused by the ingestion of food contaminated with Ascaris eggs from faeces and is more common in places with poor sanitation. Almost 25% of the world population is infested by Ascaris lumbricoides. Although ascariasis is a chronic disease, it can present as acute abdomen rarely. The wandering nature of Ascaris in and out of the bowel causes various abdominal complications such as intestinal obstruction, perforation, biliary ascariasis, pancreatic ascariasis, liver abscess, appendicitis, and Meckel's diverticulitis. Intestinal obstruction is the most common complication seen in children and is usually due to mechanical bowel obstruction, volvulus or intussusception. Mechanical obstruction by a bolus of worms is the most common cause of bowel obstruction. Perforation of bowel is rarely reported and it usually occurs in the diseased segment of bowel or following trauma. Perforation of an ileal volvulus secondary to ascariasis has been reported rarely. We present a 4-year-old boy who presented to the emergency room with features of bowel perforation and sepsis, after unsuccessful management for intestinal obstruction in another hospital. On laparotomy, the small bowel was teaming with Ascaris worms. Ileum showed a volvulus with closed loop obstruction and perforation. Peritoneal lavage with resection and ileostomy was done, which was closed at a later date. Anti-helminthic agents were started postoperatively and the boy recovered uneventfully.
... Louw 23 , in a review, found intestinal obstruction, biliary tract diseases, pancreatic diseases, peritonitis and appendicitis due to roundworms. Mishra PK et al. 24 and Wani I et al. 25 in their respective studies also found the similar abdominal complications and even the involvement of meckle's diverticulam. In the present study we observed near to same set of abdominal complications. ...
... This entire cycle lasts approximately 2 months [5]. According to estimates, approximately a quarter of the world population would be infected and about 60,000 people die yearly from the disease [6,7]. Especially those who live in crowded and dirty, places with improper drainage of sewage [8], parasite causing them a slow development, affecting both physical and mental health [9,10] by nutritional deficiencies induced [11,12] by several pathophysiological mechanisms: Intestinal inflammation, competition for nutrients, decrease hepatic protein synthesis, increasing demand for energy etc. [13]. ...
Ascaris lumbricoides is a nematode (roundworm), a parasite which inhabits the intestines of humans. This organism is responsible for the infective disease named ascariasis (a type of helminthiasis) which is prevalent in deprived areas where there is often a combination of poor sanitation and a host made vulnerable by iron-deficiency anaemia, malnutrition or impairment of growth. We present a violent death case; A child aged two, who died of mechanical asphyxia that followed airway obstruction by worms of the species Ascaris lumbricoides. Death was considered a forensic case because it occurred suddenly and the child was not known with pre-existing pathological conditions. We examined this case according to the information received from the criminalistics team correlated with the macroscopic autopsy findings and histopathological examinations with results being consistent and which indicated the diagnosis of death aforementioned. The literature cites such deaths which occurred consecutively to trauma or post general anesthesia, but in this situation a possible previous injury was infirmed by necropsy and according to the criminalistics team data the child never suffered a general anesthesia, which makes us consider this particular case as a rarely seen one.
... Ascariasis is more common in pediatrics age group (2-10 years), in tropical and subtropical areas. 3,4 Approximately two million people get infested and 20,000 deaths occur every year in endemic area. 2 Clinical illness depends on parasitic load and patients may be asymptomatic or present with malnutrition, chronic abdomen pain, nausea, vomiting, abdomen distension and acute intestinal obstruction. Many patients have history of expulsion of ascaris per rectum or mouth. 2 The factor that leads to intestinal obstructions are massive number of worms, interlace and coiled up behavior, secretion of neurotoxin and peristaltic contraction. ...
p> Ascaris lumbricoids is the most common helminthes in tropical areas of developing countries around the world. Intestinal obstruction due to A. lumbricoids is a well known and serious complication in children. We report a case of six yrs female child with intestinal obstruction, who underwent laparotomy and enterotomy to remove the worm masses. Early diagnosis and surgery prevented complications and saved the life of patient.
MED Phoenix
Volume (1), Issue (1) July 2016, page: 39-40</p
... Intestinal obstruction and infestation by Ascaris is mostly seen in developing countries. [1] In most of the cases, it remains asymptomatic, however, in cases with heavy worm load, it can result in complications such as obstruction, perforation involving appendix or Meckel's diverticulum, or biliary ascariasis. [2] Incidence and severity of complications depends on factors such as a high burden of worm and worm size. ...
Background
Intestinal ascariasis is considered as state subject in our valley of Kashmir. The aim of our study was to analyse the age, clinical presentation, diagnosis, surgical complications, and management of Ascaris lumbricoides in children and adults.Methods
Total of 312 patients above 2 years of age with definite clinical and radiological diagnosis of intestinal ascariasis and associated complications were included in our study. All our patients received anthelminthic drug (Albenzadole 400 mg stat) after termination of acute phase and attached to our Out-Patient Department for follow-up. Each patient was given second dose of antihelminthic drug at second follow-up visit.ResultsTotal of 312 subjects included 131 (41.99%) males and 181 (58.01%) females. The highest number of patients was in age group of 6–10 years (46.47%). Colicky abdomen pain was the most common presentation and present in 80.12% patients followed by vomiting (64.1%). Palpable worm bolus was a cardinal sign present in 46.47% of our subjects. Two-hundred sixty-five (84.94%) patients responded uneventfully and were relieved of colic and obstruction after conservative non-operative treatment. Twenty (6.41%) patients underwent enterotomy and evacuation of worms, 2 (0.64%) subjects underwent resection anastomosis, and 8 (2.56%) patients had laparotomy and milking of worms into colon. None of patient expired during the study period.Conclusion
Ascaris lumbricoides is common cause of acute abdomen in our valley attributed to poor hygiene and low socioeconomic background. In patients of high clinical suspicion of worm obstruction, prompt investigations should be advised to reach a definitive diagnosis and prevent the development of complications. Significant efforts must be channelised at political and society levels for the prevention of this disease. Mass deworming programs should be adopted to overcome this menace.
Ascariasis is the most prevalent helminth infection in the world and leads to significant, life-long morbidity, particularly in young children. Current efforts to control and eradicate ascariasis in endemic regions have been met with significant challenges including high-rates of re-infection and potential development of anthelminthic drug resistance. Vaccines against ascariasis are a key tool that could break the transmission cycle and lead to disease eradication globally. Evolution of the Ascaris vaccine pipeline has progressed, however no vaccine product has been brought to human clinical trials to date. Advancement in recombinant protein technology may provide the first step in generating an Ascaris vaccine as well as a pan-helminthic vaccine ready for human trials. However, several roadblocks remain and investment in new technologies will be important to develop a successful human Ascaris vaccine that is critically needed to prevent significant morbidity in Ascaris -endemic regions around the world.
Ascariasis is a common public health problem of preschool and primary school children in developing countries like Pakistan. The aim of the present study was to determine the prevalence and pattern of Ascaris lumbericoides (A. lumbricoides) infection among children residing in urban areas of Lahore, to provide information on ascariasis to promote awareness and prevention programs between the participants specially on the months or season of higher prevalence. To investigate the prevalence of Ascaris Lumbricoides in the contaminated faecal samples of children residing in urban areas of Lahore, a study was conducted from November 2010 to October 2012 and we collected 3600 stratified faecal samples from six urban study areas. Overall 32/3600 (0.88%) prevalence of fecal samples was found positive for eggs of Ascaris lumbricoides. Area wise highest presence positivity 1.67% was observed in Allama Iqbal Town followed by 1.17% in Samanabad, 1.00% in Wapda Town, 1.00% in Gulberg, 0.50% in Cantt, and the lowest 0.00% in Valencia Town respectively (p < 0.001) The highest month wise positivity prevalence 3/300 (3.33%) (p < 0.001) was observed in the month of September that gradually declined up to 0/300 (0.00%) in the month of March. The results reveal that urban areas of Lahore are susceptible to Ascaris Lubricoides infection and the highest prevalence were observed autumn on the month of September. About 2 billion people in the world are infected with at least one species of Soil Transmitted Helminths (STH) i.e., one billion due to A. lumbricoides and 4 billion are at risk 1. Globally about 1.5 billion people are affected by Ascaris lumbricoides (A. lumbricoides) infection. Children are susceptible to infestation with environmental and socioeconomic status which has influence on child health, as risk factors 2. Ascaris lumbricoides (A. lumbricoides) is a Soil Transmitted Helminth (STH) commonly distributed in tropical and subtropical areas, is a common nematode infecting human with increased prevalence (%) due to poor sanitary conditions. About 4 billion people are at risk, 613 million are specifically school-age children 3. Studies revealed that poor sociodemographic and socioeconomic status of the children are important factors for the presence of high prevalence of STH. The presence of STH is higher in rural areas than urban areas due to poor infrastructural facilities and improper sewage system 4. Inadequate water supply, contact with contaminated soil, walking bare footed, do not wash hands before eating and after defecation in early childhood when they are incautious for self-hygiene, eating raw vegetables and low SocioEconomic Status (SES) enhanced the prevalence to get ascariasis 5. The golden period for betterment in good physical and mental developmental health of children is in their early childhood, provided by the parents and society 6. Adult worm lives in small and large intestine 7,8 of man and its eggs passed out via faeces 9 of infected person to soil and contaminate it 10. Eggs in soil are transmitted to water, vegetables, food, seats of commodes, handles OPEN
Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan
Worm infestations are still quite common in the whole world and more so prevalent in tropical countries. Ascariasis is one of the most common form of parasitic infections in humans. It is found in any part of the gastrointestinal tract, including hepatobiliary system as well. It can present as a wide range of clinical spectrum ranging from asymptomatic carriers to anemia, bowel obstruction, cholangitis, and obstructive jaundice besides other manifestations. Various diagnostic modalities are used to establish diagnosis of this condition including clinical examination, ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP). Most of the times, medical management is sufficient; however, many times due to complications associated with these worms, endoscopic or surgical intervention is required. In this review, we will discuss various clinical features, diagnostic modalities, and treatment options of this disease.
Ascariasis is a common public health problem of preschool and primary school children in developing countries like Pakistan. The aim of the present study was to determine the prevalence and pattern
of Ascaris lumbericoides (A. lumbricoides) infection among children residing in urban areas of Lahore, to provide information on ascariasis to promote awareness and prevention programs between the participants specially on the months or season of higher prevalence. To investigate the prevalence of Ascaris Lumbricoides in the contaminated faecal samples of children residing in urban areas of Lahore, a study was conducted from November 2010 to October 2012 and we collected 3600 stratified faecal samples from six urban study areas. Overall 32/3600 (0.88%) prevalence of fecal samples was found positive for eggs of Ascaris lumbricoides. Area wise highest presence positivity 1.67% was observed
in Allama Iqbal Town followed by 1.17% in Samanabad, 1.00% in Wapda Town, 1.00% in Gulberg, 0.50% in Cantt, and the lowest 0.00% in Valencia Town respectively (p < 0.001) The highest month wise positivity prevalence 3/300 (3.33%) (p < 0.001) was observed in the month of September that gradually declined up to 0/300 (0.00%) in the month of March. The results reveal that urban areas of Lahore are susceptible to Ascaris Lubricoides infection and the highest prevalence were observed autumn on the month of September.
Human parasitic enteric nematodes are a major cause of morbidity and mortality worldwide with over a billion of people being infected by these parasites and over 70,000 deaths per annum.¹ Parasitic infections are endemic in many areas of the world, particularly in the subtropics and tropical regions. High-risk groups include developing regions with ineffective sanitation and education, people with weakened immune systems and children. Human enteric nematodes are transmitted by ingestion of eggs, direct penetration of larvae through the skin or rarely by inhalation. Once the eggs or larvae are within the human host, they migrate and develop into adults within the intestine where they can be carried asymptomatically, or they can cause an acute self-limiting illness, chronic infection or less commonly a severe life-threatening illness due to complications of carriage. Diagnosis is generally by identifying parasitic eggs in the faecal specimen. Once diagnosis is confirmed, anti-helminth treatment is initiated. Rarely complications occur such that surgical intervention is warranted. Prevention is the long-term goal for control of nematodal disease which includes improving sanitation, education and hygiene.
Ascaris lumbricoides is considered the largest intestinal nematode with a higher incidence in the childhood, representing a truly medical and public health problem, principally in undeveloped countries. We present the case of an 83 year old man, born and coming from the amazon region, without any relevant previous history of disease, admitted in the emergency department of our hospital for presenting intestinal obstruction and also presumptive biliary obstruction due to multiple balls of parasites, requiring immediate surgical intervention. We emphasize the need of consider this etiologic possibility in the differential diagnosis, that in this particular case, wasn't suspected in the first place.
Objective
Ascaris-induced small bowel obstruction (SBO) is a common sequel of Ascaris lumbricoides (AL) infestation. Most cases respond to conservative treatment practiced in different centers worldwide. We conceived a prospective randomized trial to compare the conservative treatment with gastrografin administered in addition to the conservative treatment.
Study design
This prospective randomized study was conducted between January 2011 and June 2014 at Department of Paediatric and Neonatal Surgery, a tertiary-care hospital. Patients were divided into two groups, one group received conservative treatment and the other received gastrografin in addition to conservative treatment. Forty patients having uncomplicated AL-induced SBO were included in each group. Gastrografin was administered through nasogastric tube and serial clinical and radiological monitoring was performed. The duration of hospital stay, time between admission and first oral feed, passage of worms/flatus were compared in the two groups. Student’s t test was used for comparing these variables.
Results
Average time for passage of flatus or worms and resolution of abdominal signs and was shorter in gastrografin group as compared to the conservative group. This difference was found to be statistically significant. The average duration of hospital stay in gastrografin group was 25.20 ± 8.01 h whereas it was 61.12 ± 14.64 h in the conservative group (P < 0.001). The difference in the operation rate was statistically insignificant (2 in gastrografin group and 3 in the conservative group).No serious adverse reaction was noted after gastrografin administration.
Conclusion
Use of gastrografin resulted in faster relief of signs and symptoms of AL-induced SBO, early passage of worms/flatus and return to oral feeds. However, the role of gastrografin role in reducing the likelihood of laparotomy remains inconclusive. Adverse effects of gastrografin can be prevented if it is used in well-hydrated patients.
Background: Childhood intestinal obstruction can either be congenital or acquired and both types result in high morbidity and mortality in developing countries, mainly as a result of late presentation and diagnosis. Patients and methods: From January 2007 to December 2010, a retrospective analysis of all older children with intestinal obstruction admitted to Komfo Anokye Teaching Hospital (Kumasi, Ghana) was carried out. This was to establish the causes of intestinal obstruction and to determine its morbidity and mortality among the children studied. Results: There were 98 children who were treated with a diagnosis of intestinal obstruction during the period. The mean age of the children, in months, was 34.7±5.0 SEM (range 3-180, median age 10 months), with a male : female ratio of 1.5 : 1. About 70.6% of the children were admitted with acquired causes of intestinal obstruction and 29.4% with congenital causes of intestinal obstruction. In all, 21.2% of the children, treated for intestinal obstruction, underwent bowel resection as a result of nonviability of a segment of the intestine; the majority of the bowel resections were performed in the intussusception group. The mean length of hospital stay, in days, was 8.2±5.7. There were 15 children (15.3%) with various postoperative complications, mainly surgical site infections; the mortality rate was 11.2%. Here again, most of the deaths occurred in the intussusception group of children. Conclusion: Intestinal obstruction is a serious emergency in children and must be diagnosed early and treated promptly to avoid high morbidity and unnecessary deaths among children in our subregion.
Soil samples showed an overall prevalence 1.79 % of Ancylostoma duodenale"s eggs in six slums of Lahore, Punjab from Nov 2006 to Oct 2008. Significant prevalence was observed in Missrisha (0.89 %) followed by Bhutto Colony (0.83 %) , Siddiquia Colony (0.72 %), Khairdin Park (0.53 %), Sheikhupura Road (0.39 %) whereas lowest in Scheme No 2 (0.22 %) respectively. Season wise high prevalence was observed in autumn (3.92 %), summer (1.88 %) and winter (1.29 %) as compared to spring (0.50 %). Month wise highest prevalence (4.83 %) was observed in October followed by 3.67 % in September that gradually decreased to 0.83 % in December and declined to 0.50 % in March respectively. Demographic data showed 33.47 % people used gurkies / pit, 27 % defecated in open fields, 23 % had very poor sewerage system and 14.52 % availed satisfactory sewage conditions. Children who had habit of pica (10.50 %), nail biting (12.51%), sucking thumb (11 %), did not wash hand before meal (12.10 %), after defecation (21.76 %), walked bare footed (25.51 %) and used junk food (7.54 %) were found respectively.
The purpose of this study is to bring new and important data regarding the epidemiology of ascariasis, enterobiasis and giardiasis in the Romanian largest county during a 14-year period. We have performed a retrospective collection and analysis of the available information provided by the general practitioners to the Statistics Department database of the Timis County Public Health Authority. The mean annual incidence of the studied parasitic diseases during 1993-2006 was the following: 194 cases per 100,000 inhabitants (range: 90-304) for ascariasis, 777 cases per 100,000 inhabitants (range: 417-1241) for enterobiasis and 1076 cases per 100,000 inhabitants (range: 93-1770) for giardiasis. Noteworthy is that Romania reported 90.8% of the total cases of giardiasis at the European Union's level during 2006-2008. The general trend of the incidences throughout the studied period was constant for ascariasis (R(2)=0.192, p=0.1), showed no statistically significant variation (R(2)=0.025, p=0.6) for enterobiasis and was upward for giardiasis (R(2)=0.6, p=0.001). Intestinal parasitoses represent an important public health concern in Romania due to the extremely high incidence rates reported. Special attention should be paid to the young population (0-14 years), where the negative disease consequences on children's health and their educational process may be traced for a long-term. Therefore, efficient educational programs and campaigns should be timely implemented.
Prevalencνa de parasitosis intestinales en niρos de zonas urbanas del estado de Colima
- G C Dαvila
- H B Trujillo
- C Vαsquez