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Primary ascaridial perforation of the small intestine: sonographic diagnosis

Ashish Chawla1, Vasudha Patwardhan, Mohit Maheshwari

  • 1Department of Radiology, King Edward VII Memorial Hospital, Parel, Mumbai 400012, India.

Journal of Clinical Ultrasound : JCU
|April 15, 2003
PubMed

Insights

Ascariasis, a common infection, can cause severe intestinal issues. This case highlights how ultrasound accurately diagnosed a child's perforation caused by Ascaris lumbricoides, enabling timely surgery and recovery.

Area of Science:

  • Medical Imaging
  • Parasitology
  • Pediatric Surgery

Background:

  • Ascariasis, caused by Ascaris lumbricoides, is a prevalent human helminthic infection.
  • Complications like intestinal obstruction and perforation pose significant mortality risks, necessitating early diagnosis and treatment.

Observation:

  • A 5-year-old girl presented with clinical symptoms suggestive of ascariasis complications.
  • Sonography revealed characteristic features of Ascaris lumbricoides within the peritoneal cavity and small bowel loops.
  • The sonographic appearance of each ascarid was described as two parallel lines (outer margins) flanking a central sonolucent line (digestive tract).

Findings:

  • Ultrasound successfully diagnosed ascaridial perforation, identifying worms in the peritoneal cavity and ileum.
  • Emergent laparotomy was performed for worm removal from the peritoneal cavity and terminal ileum.
  • The patient experienced a full recovery and remained asymptomatic at a 3-month follow-up.

Implications:

  • This case underscores the utility of sonography in diagnosing parasitic complications, particularly in pediatric patients in endemic regions.
  • Familiarity with the sonographic signatures of Ascaris lumbricoides can improve diagnostic accuracy and patient outcomes.
  • Early sonographic detection of ascaridial perforation facilitates prompt surgical intervention, reducing morbidity and mortality.

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