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Abdominal complications of ascariasis in childhood
Ivonete Siviero1, Ugo V B de Almeida2, Claudia R R Penna2
1Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Cirurgia, Rio de Janeiro, RJ, Brazil.
Insights
Ascariasis complications in children, particularly intestinal obstruction, require prompt diagnosis and treatment. Ultrasonography is key for diagnosing rarer hepatobiliary and pancreatic issues in pediatric ascariasis.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Emergency Medicine
Background:
- Ascariasis complications are a frequent cause of pediatric abdominal emergencies, especially in endemic regions.
- Understanding diagnostic and therapeutic challenges is crucial for effective management.
Purpose of the Study:
- To review and enhance diagnostic and therapeutic strategies for pediatric ascariasis complications.
- To highlight the importance of early diagnosis and appropriate treatment in endemic areas.
Main Methods:
- A comprehensive literature search was performed on PubMed using terms 'ascariasis complications' and 'hepatobiliary ascariasis'.
- Included studies encompassed meta-analyses, RCTs, clinical trials, observational studies, case reports, and reviews up to December 2023.
Main Results:
- Small bowel obstruction is the most common complication; rarer hepatobiliary, pancreatic, and appendiceal issues are more severe in children.
- Ultrasonography is the preferred imaging for hepatobiliary, pancreatic, and appendiceal ascariasis complications in children.
- Conservative treatment is standard, with surgery indicated for treatment failure or complications; laparoscopy's role in pediatric hepatobiliary ascariasis requires further study.
Conclusions:
- Developing standardized protocols and fostering discussion are essential for improved understanding of pediatric ascariasis complications.
- Early diagnosis and adequate treatment are critical for children with severe Ascaris lumbricoides infestations.
Objective:
Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients.
Data Sources:
A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023.
Summary Of Findings:
Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed.
Conclusion:
The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.
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