Small bowel obstruction caused by massive ascariasis: two case reports

Abstract

Introduction and importance: Ascaris lumbricoides is an infestation that affects approximately one-seventh of the world’s population. Ascaris lumbricoides is a common inhabitant of the intestines of people with low-socioeconomic incomes, especially in underdeveloped countries of the world. Ascaris lumbricoides infestation is more prone to infestation with serious complications such as intestinal obstruction, volvulus, intussusception, and intestinal necrosis at higher rates in children than in adults. Case presentation: The authors present here two cases of small bowel obstruction caused by massive Ascaris lumbricoides that were admitted to the pediatric surgery service after completing a clinical and physical examination, and we operated after rehydration. Both underwent surgical resection with an end-to-end anastomosis. The patient was discharged uneventfully with a plan for de-worming treatment in 6 weeks. Clinical discussion: Ascariasis is a round intestinal worm infestation transmitted by fecal or oral contamination. Eating and excreting ascaris eggs lead to ascariasis and excrete human feces, which contaminate foods, soil, and/or water in unsanitary environments. In contrast, in the first case of this study, the diagnosis was made by ultrasound and erect abdominal radiography, and, in the second case, an abdominal ultrasound result was equivocal and required an abdominal computed tomography scan for confirmation. Treatment of small bowel obstruction by roundworms is usually surgical, but in the absence of signs of peritonitis, medical management can give effective results, even in the case of total obstruction. Conclusion: The type of surgery undertaken is determined by the results of the laparotomy. If the bowel was found to be intact and the obstruction was at the ileum level, milking worms to the cecum can be done with caution to avoid trauma to the bowel wall. Primary anastomosis after resection of a necrotic bowel segment and removal of the worm bolus is a suitable method for treatment of the ascariasis obstruction.

Presentation of Ascariasis as a Cause of Acute Intestinal Obstruction

“…However, in instances when there are a large number of worms, they may aggregate into a mass and lead to blockage or rupture of the small intestines. Worm bolus blockage is a significant factor in causing intestinal obstruction in children [ 10 ]. Roundworms may also travel via the ampulla of Vater to reach the biliary system and pancreas, resulting in biliary colic, acute cholangitis, acute cholecystitis, and pancreatitis.…”

A Teenage Boy with Abdominal Pain and Vomiting

“…Unless the environment becomes intolerable for them, they often live in the intestines without causing major symptoms. Serious symptoms like pancreatitis, cholecystitis, liver abscess, intestinal obstruction, volvulus, and even perforation manifest during their migration 6 . Gut obstruction from conglomerate and lodged big worms is the most common complication; it may also be accompanied by volvulus or intussusception 1,3 .…”