Jejunal perforation caused by schistosomiasis

Singh, Naorem Gopendro; Mannan, Abul Ala Syed Rifat; Kahvic, Mirza; Alanzi, Farhan M. N.

doi:10.1258/td.2010.090352

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…The worm burden in the intestine is not inconsequential. Jejunal perforation due to adult worms has been reported [29]. The urinary system is also a target.…”

Section: Discussionmentioning

confidence: 99%

An Unexpected Epidemic: Schistosomiasis and Strongyloides Infections Detected in an Academic Urban Community GI Practice. A Case Series of 104 patients

Brown¹

2013

Glob. J. Gastroenterol. Hepatol.

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A gastroenterologist's practice in a Boston metropolitan academic community hospital was reviewed for all cases of parasitic disease seen in that practice as part of routine GI referral patterns from October 10, 2009 to September 9, 2013. The practice did not specialize in the treatment of parasitic diseases. 104 patients were identified and evaluated for their methods of diagnosis, treatment, laboratory values and types of parasites. Serological results for all testing done by health care providers at the Cambridge Health Alliance (CHA) for Strongyloides stercoralis and Schistosomiasis (all species) were then reviewed for two one year periods. The study patients had parasitic infections that reflected the infestations endemic in their countries of origin. Language was used as a surrogate for the patient's country of origin. The methods used for the diagnosis of parasitic infections included serologic studies (98/104: 94.2%), pathological examination of biopsy specimens with serology (19/104: 18.3%), pathological examination alone (6/104: 5.8%) and fecal ova and parasite testing (O&P) (2/104: 1.9%). 93/104 (89.4%) of the patients had a positive serology for Schistosomiasis, Strongyloides or both. None of the Schistosomiasis or Strongyloides patients were detected or confirmed with O&P studies (0/103: 0.0%). Several neoplastic lesions of the gut were noted (16/104: 15.4%), of which 3 (3/104: 2.9%) were adenocarcinomas of the colon. Tissue biopsy is a specific test. Schistosomiasis and Strongyloides serology are sensitive tests. Given the short time needed to treat these infections, and the relatively safe side effect profile for these therapies, the use of antibody and pathological testing with treatment of positive results seems to be a reasonable approach. Evaluation for parasites in asymptomatic, newly arrived immigrants and individuals with a distant history of immigration or travel to areas at risk (especially patients with eosinophilia) should be done as part of their routine health care. Transplant donors originally from endemic areas should have serological examination for Strongyloides stercoralis and Schistosoma species prior to organ transplant or fecal microbiota transplantation (FMT). All patients at risk for these infections should be diagnosed and treated prior to immunosuppressive therapy. This is especially true for patients with Strongyloides, given the unacceptable high mortality rate of hyperinfection syndrome. Such a strategy may prevent the consequences of chronic parasitic infestations and limit a potential public health hazard.

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“…The worm burden in the intestine is not inconsequential. Jejunal perforation due to adult worms has been reported [29]. The urinary system is also a target.…”

Section: Discussionmentioning

confidence: 99%

An Unexpected Epidemic: Schistosomiasis and Strongyloides Infections Detected in an Academic Urban Community GI Practice. A Case Series of 104 patients

Brown¹

2013

Glob. J. Gastroenterol. Hepatol.

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“…1 Bowel obstruction has previously been reported in this patient population but, with the exception of a case from Kuwait of jejunal perforation, 2 a French case of rectal perforation, 3 and a case of sigmoid colonic obstruction resulting in perforation, 4 there are no recorded cases of large bowel perforation in an individual positive for human immunodeficiency virus (HIV) in the literature. We report an unusual cause of large bowel obstruction with associated perforation and discuss the etiology.…”

Section: Introductionmentioning

confidence: 90%

Intestinal schistosomiasis presenting as large bowel perforation in an HIV-positive individual

Cadwallader¹,

Thirsk²

2011

RRTM

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Endemic to over 70 countries and resulting in 200 million infected individuals and 500,000 deaths each year, the Schistosoma trematode worm can result in multisystem morbidity. Bowel obstruction secondary to this parasite has previously been described, but we report the first case of schistosomiasis affecting the sigmoid colon and resulting in perforation in a male positive for human immunodeficiency virus.

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Perforation of small bowel caused bySchistosoma japonicum: A case report

Xiang

Cheng

Tian

et al. 2015

WJG

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A 67-year-old man from Jingzhou was admitted to the First Hospital Affiliated to Yangtze University in July 2013 with sudden onset of abdominal pain with dizziness for 12 h. The patient had sign of peritoneal irritation. Ultrasonography of the abdomen and pelvis showed hepatic fibrosis due to schistosomiasis. Computed tomography showed free gas in the peritoneal cavity. Plain abdominal radiography showed bilateral subdiaphragmatic accumulation of gas, perforation of the viscus, and radio-opacity in the left renal area. The patient underwent emergency exploratory laparotomy. At laparotomy, a moderate amount of muddy yellow pus was found in the intra-abdominal cavity. At the junction of the jejunum and ileum, about 250 cm from Treitz's ligament, there was an about 10-cm length of inflamed small bowel with perforation (3 mm in diameter) along the mesenteric border at the middle of the lesion. The patient underwent resection of the affected intestinal segment, along with end-to-end intestinal anastomosis. Histopathological examination revealed mucosal necrosis and hemorrhage with a large number of infiltrating eosinophils and neutrophils, and acute submucosal inflammation with a large number of infiltrating eosinophils and neutrophils associated with Schistosoma japonicum (S. japonicum) eggs. No intravascular adult parasite was found. Postoperatively, the patient was treated with praziquantel (30 mg/kg daily) for 4 d. The patient progressed well. To the best of our knowledge, this is the first case of small bowel perforation associated with eggs of S. japonicum.

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Jejunal perforation caused by schistosomiasis

Abstract: We report an extremely unusual case of jejunal perforation caused by adult schistosoma worm in a 49-year-old South Korean man who presented with acute abdomen. To our knowledge, this is the first case of jejunal perforation associated with adult worm of schistosoma.

Cited by 3 publications

References 4 publications

An Unexpected Epidemic: Schistosomiasis and Strongyloides Infections Detected in an Academic Urban Community GI Practice. A Case Series of 104 patients

An Unexpected Epidemic: Schistosomiasis and Strongyloides Infections Detected in an Academic Urban Community GI Practice. A Case Series of 104 patients

Intestinal schistosomiasis presenting as large bowel perforation in an HIV-positive individual

Perforation of small bowel caused bySchistosoma japonicum: A case report

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