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Intestinal obstruction in children due to Ascariasis: a tertiary health centre experience
P K Mishra1, A Agrawal, M Joshi
1Department of Paediatric Surgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India.
Insights
Ascariasis causing bowel obstruction in children is common in tropical regions. Conservative management, including hypertonic saline enemas, successfully treated 84.47% of cases, with surgery reserved for severe presentations.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Ascariasis, caused by Ascaris lumbricoides, is a prevalent intestinal nematode infection in tropical areas, often linked to poor sanitation.
- Bowel obstruction due to ascariasis is a significant surgical emergency in children, particularly in endemic regions.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic methods, and management strategies for intestinal obstruction caused by Ascaris lumbricoides in children.
- To evaluate the effectiveness of conservative management for Ascaris-induced bowel obstruction.
Main Methods:
- A 5-year retrospective study of 103 children diagnosed with intestinal obstruction due to Ascaris lumbricoides.
- Diagnosis was confirmed by clinical history (worm passage), X-ray, and ultrasonography.
- Patients were managed conservatively with hypertonic saline enemas, with a follow-up period of one year.
Main Results:
- Abdominal pain and vomiting were the most frequent symptoms. Documented worm passage occurred in 63 children.
- Conservative management, aiming to 'starve the worm and hydrate the patient,' was successful in 87 children (84.47%).
- Sixteen children (15.53%) with abdominal guarding or rigidity required emergency surgical intervention.
Conclusions:
- Intestinal obstruction due to Ascaris lumbricoides should be considered in the differential diagnosis of pediatric bowel obstruction.
- Clinical evaluation combined with imaging (X-ray, ultrasound) aids in diagnosis.
- Conservative management is effective for most cases, but surgical intervention is necessary for patients presenting with guarding or rigidity.
Background:
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.
Materials And Methods:
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.
Results:
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.
Conclusion:
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.
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