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Intestinal obstruction in a child with massive ascariasis and associated acute appendicitis: A case report
Abdinasir Mohamed Elmi1, Cihan Çelik1, Shuayb Moallım Alı Jama1
1Radiology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Somalia.
Insights
Ascariasis, a common roundworm infection, can cause severe intestinal obstruction in children. This case highlights the need for prompt diagnosis and surgical intervention for Ascaris lumbricoides-induced bowel obstruction.
Area of Science:
- Medical parasitology
- Pediatric surgery
- Gastroenterology
Background:
- Ascariasis is the most prevalent helminthic infection globally, particularly affecting children aged 2-10 in areas with poor sanitation.
- Risk factors include environmental and socioeconomic conditions, leading to complications like intestinal obstruction, volvulus, intussusception, and necrosis.
Observation:
- A 6-year-old boy presented with acute abdominal pain, constipation, and vomiting, indicative of intestinal obstruction.
- Physical examination revealed abdominal distension and tenderness. Imaging confirmed intestinal obstruction by Ascaris lumbricoides, with associated acute appendicitis.
Findings:
- Exploratory laparotomy revealed a massive intraluminal nematode burden from the jejunum to the ileocecal valve.
- An ileal enterotomy was performed for worm removal. The patient recovered and was discharged on day 12.
Implications:
- Intestinal ascariasis, especially in preschool children presenting with acute intestinal obstruction, requires high clinical suspicion.
- While medical treatment is often effective, surgical intervention may be necessary for severe cases of bowel obstruction caused by Ascaris lumbricoides.
Introduction And Importance:
Ascaris lumbricoides is a parasitic roundworm that spread through feces-oral routes and is endemic in many nations with poor sanitation.
Case Presentation:
We present a case of a 6-year-old boy who arrived in the emergency room with abdominal pain, constipation, and vomiting. Physical examination revealed abdominal distension, absence of bowel sounds, and abdominal tenderness. Abdominal radiographs, ultrasonography, and computed tomography established the diagnosis of intestinal obstruction by A. lumbricoides with associated acute appendicitis and surgical approach scheduled. A massive intraluminal nematode from the jejunum to the ileocecal valve was observed during an exploratory laparotomy. An ileal enterotomy was performed and the worms were removed. The patient was discharged without incident on the 12th day.
Clinical Discussion:
Ascariasis is the most common helminthic infection worldwide; reaching peak prevalence in children aged 2 to 10. The disease is prevalent in children with environmental and socioeconomic risk factors, causing serious problems such as intestinal obstruction (IO), volvulus, intussusception, and intestinal necrosis.
Conclusion:
Ascaris lumbricoid is very prevalent in developing countries and should be kept in mind in preschool children with symptoms of sudden acute intestinal obstruction. The diagnosis of intestinal ascariasis can usually be made with plain radiography, barium examinations, and ultrasonography of the abdomen. Other modalities, such as CT, can also be used. Medical treatment of Ascaris infestation is usually successful; however, bowel obstruction may require surgery.
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