[Volvulus of the small bowel due to ascaris lumbricoides package: about a case]
Cheikh Diouf1, Ahmed Kane2, Ndeye Aby Ndoye3
1Service de Chirurgie, Hôpital Régional de Ziguinchor, Université Assane Seck de Ziguinchor, Sénégal.
Insights
Ascaris lumbricoides caused a rare case of small bowel volvulus in a child. Surgical intervention and resection led to a favorable outcome and symptom resolution after two years.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Intestinal obstruction is a common surgical emergency in children.
- Ascariasis, caused by Ascaris lumbricoides, is a prevalent helminthic infection globally, particularly in endemic areas.
- While ascariasis can cause various gastrointestinal complications, small bowel volvulus is an exceptionally rare presentation.
Observation:
- A 7-year-old child presented with a two-day history of intestinal obstruction and altered general status.
- Abdominal radiography revealed small bowel air-fluid levels and a 'tiger-stripe' appearance, suggesting acute intestinal obstruction with an abdominal mass.
- Surgical exploration (laparotomy) identified a necrotic volvulus of the terminal ileum containing adult Ascaris lumbricoides.
Findings:
- The patient underwent emergency laparotomy for necrotic small bowel volvulus.
- A one-meter segment of the affected terminal ileum was resected, and an ileostomy was performed.
- Postoperative recovery was favorable, with a successful ileorectal anastomosis performed four weeks later.
Implications:
- This case highlights Ascaris lumbricoides as a rare but critical cause of pediatric intestinal obstruction and volvulus.
- Prompt surgical management, including resection and diversion, is crucial for favorable outcomes in such cases.
- Long-term follow-up is important to ensure complete recovery and absence of recurrence.
Abstract:
We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.
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