Ascaris lumbricoides is a common nematode infecting humans worldwide with increased Here, we present a case of an intestinal ascariasis. Background With one quarter of the world population infected, the intestinal nematode Ascaris lumbricoides is one of the most common. of Ascaris lumbricoides and Necator americanus distributions in Manufahi District , Timor-Leste. Rebecca Wardell1, Archie C. A. Clements1.
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The most common causes of acute abdomen are acute appendicitis, acute peptic ulcer, acute cholecystitis, acute pancreatitis, intestinal obstruction, acute peritonitis and acute pyelonephritis . One cause of intestinal obstruction by parasites is A.
The most commonly known serious and lethal complication of A. Early diagnosis of intestinal obstruction caused by A. Emergency surgical treatment may be necessary in acute intestinal obstruction in which the mass of the parasite obstructs the intestinal lumen or intestinal obstruction develops due to volvulus . Meanwhile, subacute cases are successfully treated conservatively until spontaneous resolution [3,12].
The aim of this report is to present a case of bowel obstruction caused by A. A year-old boy from Tokh El Khail, Minia governorate, Egypt, was admitted to the emergency department of Minia University Hospital, Minia, Egypt, on 10 Marchwith acute colicky periumbilical abdominal pain not referred to other sites, vomiting and constipation for 3 days.
On physical examination he had pallor and appeared poorly nourished. His oral temperature was Pulse was regular with a rate of beats per minute, and respiratory rate was 35 per minute.
Respiratory examination revealed bilateral air entry with lumbricoidss added sounds but slight respiratory effort. Cardiovascular examination ascqris normal S1 and S2 with no murmur, and central nervous system examination revealed no neurological deficits. Abdominal examination revealed abdominal tenderness and rigidity in the central and mid-abdomen. There was no organomegaly.
Auscultation revealed a silent abdomen or minimal peristalsis. At the time of admission, laboratory investigations were done. The red blood cell count was 3. The boy came from a very low socioeconomic status family. His father was a farmer and all the family helped the father, usually spending all the day working in the fields. They usually ate vegetables from the field without washing. The boy had a history of pica. Moreover, there were repeated attacks of vague abdominal pain, colic and some attacks of diarrhoea.
The boy was prepared for operation with correction of fluid and electrolyte imbalance, broad spectrum antibiotic as a prophylaxis, blood transfusion and analgesics.
No antihelminthic drug was used at this stage. Intra-operative exploration through a right lower paramedian incision revealed serous collection.
At laparotomy, he had multiple abnormal contents in the small intestine Figure 1 A. Milking was performed by hand to collect worms to the jejunum to facilitate their extrusion Figure 1 B. An enterotomy was done where an incision was done in the intestine Figure 1 C to extract worms by sponge-holding forceps Figures 1 D and E. The lumvricoides approximately filled a kidney tray Figure 1 F.
There were total 53 worms: He had very healthy appendix. Exploration was done to exclude any other affected areas as well as to rule out any area of questionable viability in the rest of the gut. The abdomen was closed with a tubal drain within it. Figure 1 Steps of surgical intervention in a case of acute abdomen caused by Ascaris lumbricoides infection.
A Abnormal multiple contents in the small intestine; B Milking of worms by hand; C Jrnal of enterotomy; D, E Extraction of worms by sponge-holding forceps; F Worms approximately filled a kidney tray.
Diagnosis of Ascaris lumbricoides infection using capsule endoscopy
The worms were sent to the laboratory of the department of parasitology at the faculty of ulmbricoides, Minia University for further identification. The worms were cylindrical in shape, pinkish in colour. Adult males measured 15 to 30 cm in length and 2 to 4 mm in diameter and their posterior end was curved with 2 spicules.
Adult females measured 20 to 40 cm in length and 3 to 6 mm in diameter and their posterior end was straight. These worms were verified as A.
On the 2nd post-operative day the patient received a single dose of albendazole mg.
Lummbricoides days post-operative stool examination revealed few Ascaris spp. He gave a history of passage of tall brown-yellow worms on the second day after taking albendazole. The child was discharged on the 4th day postoperatively without complications. Stool examination had been repeated twice on the first and the second weeks post-operative.
The dose of albendazole was repeated after 2 weeks following faecal examination. Ascariasis is a world-widely distributed parasitic infection, especially in tropical and subtropical areas where unhygienic disposal of human excreta is common. Awcaris mode of A. The fertilized eggs hatch in the intestine.
The released larvae penetrate the intestinal wall to reach the right side of the heart, pulmonary circulation and then to the alveoli. When the larvae are coughed up by the host, they are swallowed back into the intestine to develop into adult worms [3,7].
The clinical features of A. The symptomatic disease is largely restricted to individuals with a high worm load . The symptoms are related either to larval migration or to the adult worm intestinal stage.
Human Ascariasis: Diagnostics Update
Pulmonary manifestations of ascariasis are due to the larval migration through the lungs. Heavy infection with A. Heavily infected children suffer from protein malnutrition and vitamin A deficiency [13,14].
Adult worms cause serious clinical problems during their migration, including acute pancreatitis, acute cholecystitis, liver abscess, intestinal obstruction judnal present in large numbers and even perforation [2,7]. They may occasionally cause appendicitis and obstructive jaundice . The massive gastrointestinal bleeding with ulceration, perforation and even gangrene of the bowel asvaris are rare, fatal complications . Since it is clearly obvious from the clinical manifestations and complications of A.
The management of the majority of cases of uncomplicated asxaris can be done successfully with antiparasitic drugs such as qscaris, mebendazole or pyrantel pamoate [17,18]. Meanwhile, complicated cases of ascariasis can be managed by surgical intervention. The type of surgery depends on the findings during laparotomy. If the bowel is viable and the obstruction is at the lumbricoidws of ileum, milking of the worms to the caecum can be done carefully without causing trauma to the bowel wall .
If the obstruction is at the level of the jejunum and if there are multiple masses, enterotomy should be done through a longitudinal incision with removal of worms by sponge-holding forceps.
The incision should be closed transversally with great care to avoid contamination of the peritoneal cavity by the worms or their eggs. In cases where the intestinal wall is thin, for example in cases of volvulus, milking should not be attempted as this may cause serosal tears. Enterotomy is preferred in such cases. Breaking lumbriccoides the worms during milking should be avoided as this may release toxins. In cases presenting with bowel gangrene, perforation, or intussusception with non-viable bowel, resection with primary anastomosis may be required [20,21].
In our case, enterotomy was performed to remove the worms after careful milking of the worms, as multiple abnormal contents in the small intestine had been found at laparotomy. The early diagnosis of complicated ascariasis and surgical intervention are essential to minimize high morbidity lumbricoidex mortality of complicated ascariasis. The awareness of ascariasis and its preventive measures should be included in all health education programmes and should be delivered to schoolchildren and their mothers to overcome the risk of infection.
Volume 24, number 10, October Pan Lumbrcioides Journal of Public Health.
Human Ascariasis: Diagnostics Update
YouTube Rss feeds Twitter Facebook. Ascaris lumbricoides causing acute abdomen: Eastern Mediterranean Health Journal. Case report A year-old boy from Tokh El Khail, Minia governorate, Egypt, was admitted to the emergency department of Minia University Hospital, Minia, Egypt, on 10 Marchwith acute colicky periumbilical abdominal pain not referred to other sites, vomiting and constipation for 3 days.
A Abnormal multiple contents in the small intestine; B Milking of worms by hand; C Performance of enterotomy; D, E Extraction of worms by sponge-holding forceps; F Worms approximately filled a kidney tray The worms were sent to the laboratory of the department of parasitology at the faculty of medicine, Minia University for further identification.
Discussion Ascariasis is a world-widely distributed parasitic infection, especially in tropical and subtropical areas where unhygienic disposal of human excreta is common.
References De Silva NR et al. Trends in Parasitology, Eastern Mediterranean Health Journal, Schulze SM et al. Acute abdomen secondary to Ascaris lumbricoides infestation of the small bowel. American Surgeon, Steinberg R et al. Unusual intestinal sequelae after operations for Ascaris lumbricoides infestation.
Pediatric Surgery International, Hotez PJ et al. Rescuing the bottom billion through control of neglected tropical diseases. Dold C, Holland CV.