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Intestinal ascariasis in children
Imtiaz Wani1, Muddasir Rather, Ghulam Naikoo
1Department of Surgery, S.M.H.S. Hospital, Srinagar, Kashmir, 190009, India. imtazwani@gmail.com
Insights
Symptomatic intestinal ascariasis in children commonly presents with abdominal pain and distension. Most cases can be successfully managed conservatively, with surgery reserved for severe complications of ascariasis.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Ascariasis is a significant health issue in endemic regions, frequently affecting children.
- Ascaris lumbricoides infections can lead to severe surgical complications, particularly intestinal obstruction in pediatric patients.
- While conservative management is common, understanding clinical presentation and outcomes is crucial.
Purpose of the Study:
- To investigate the clinical presentation of symptomatic intestinal ascariasis in children.
- To evaluate the management strategies and outcomes for pediatric intestinal ascariasis.
- To identify key diagnostic features and treatment approaches for this condition.
Main Methods:
- A prospective study conducted over three years (2006-2009) included pediatric patients with symptomatic intestinal ascariasis.
- Clinical history, physical examination, abdominal X-rays, and ultrasonography were utilized for diagnosis.
- Surgical findings were documented for patients undergoing operative intervention.
Main Results:
- The study involved 360 pediatric patients, with the 4-7 year age group being most affected.
- Abdominal pain (99%) and distension (63%) were the predominant symptoms and signs.
- Radiological imaging confirmed worm masses in 23% (X-ray) and identified complications like interloop fluid (49%) via ultrasound.
- Conservative management was successful in 78% of cases, while 22% required surgical intervention, with a 1% mortality rate.
Conclusions:
- Intestinal obstruction due to ascariasis is a prevalent condition in children in the Kashmir region.
- Abdominal pain is the hallmark symptom of intestinal ascariasis.
- Plain X-ray and abdominal ultrasonography are valuable diagnostic tools for intestinal ascariasis.
- The majority of pediatric patients with intestinal ascariasis can be effectively treated with conservative measures.
Background:
Ascariasis is a staggering health problem commonly seen in children of endemic areas. In the abdomen, ascaris lumbricoides can cause a myriad of surgical complications. Intestinal obstruction by ascaris lumbricoides is commonly seen in children. Most cases are managed conservatively. The purpose was to study the clinical presentation and management of symptomatic intestinal ascariasis in children.
Methods:
A 3-year study was performed from April 2006 to April 2009 of pediatric-age patients who had symptomatic intestinal ascariasis. All patients had detailed clinical history, examination, plain X-ray of abdomen, and ultrasonography of abdomen. Peroperative findings were recorded in all patients who had surgical intervention.
Results:
This prospective study had 360 patients. Male to female ratio was 1.37:1. 187 patients (52%) presented within 2-4 days of duration of illness. Mean +/- standard deviation (SD) age of patients was 6.35 +/- 2.25 years. Age group of 4-7 years (80%) was commonest group affected. Abdominal pain was a leading symptom in 357 patients (99%) with the pain in periumbilical area present in 215 patients (60%). In 227 patients (63%) abdominal distension was seen and was the commonest physical finding. Palpable worm masses were seen in 129 patients (36%); 81 patients (63%) had palpable worm masses in the umbilical quadrant. On X-ray of abdomen, visible worm masses were seen in 83 patients (23%). Abdominal sonography showed interloop fluid in 177 patients (49%) and free fluid in the pelvis of 97 patients (27%). The number of patients who were managed conservatively was 281 (78%), and 79 patients (22%) had surgical intervention. In patients who had surgical intervention, 39 patients (49%) had enterotomy and 7 patients (9%) had kneading of worms. Postoperative complications occurred in 33 patients, and an overall mortality of 1% (1 patient) was seen.
Conclusions:
Ascaridial intestinal obstruction is common in children in the Kashmir. Abdominal pain is the leading symptom in intestinal ascariasis. Plain X-ray and ultrasonography of the abdomen are used to diagnosis intestinal ascariasis. The majority of the patients can be managed conservatively.
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