Intestinal ascariasis – image

How to cite this article:
Rai S. Intestinal ascariasis – image. Ann Trop Med Public Health 2010;3:33-4

 

How to cite this URL:
Rai S. Intestinal ascariasis – image. Ann Trop Med Public Health [serial online] 2010 [cited 2020 Aug 11];3:33-4. Available from: https://www.atmph.org/text.asp?2010/3/1/33/76184

Sir,

A 14-year-old boy presented with recurrent abdominal pain. Ultrasound, computed tomography (CT), and blood investigations were negative. Medical treatment was unsuccessful and a surgical condition was suspected. A Barium investigation was sought for in our department. An abdominal radiograph was performed which demonstrated characteristic findings of Ascaris lumbricoides infestation. A worm-like structure which was outlined by gas was seen within the lumen of a small intestinal loop [Figure 1]. No air was seen within the worm. The patient was treated medically since there were no features of intestinal obstruction and no bolus of worms were found on the small bowel series study. The patient improved after treatment.

Figure 1 :A worm-like structure which was outlined by gas was seen within the lumen of a small intestinal loop. Mildly dilated small bowel loops without air-fl uid levels.

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Ascariasis is a helminthic infection commonly found in tropical climates. It often propagates in communities of low socioeconomic status secondary to contamination of the soil and water supply with human feces. [1] In general, the gastrointestinal tract is the primary site of involvement of parasites during their lifecycle. [2]

Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. During the intestinal phase of the disease, the adult worms usually remain clinically silent, sometimes causing a variety of non-specific abdominal symptoms. [3] When present in large numbers, the worms may get intertwined into a bolus, causing intestinal obstruction, volvulus or even perforation. Large collections of coiled worms may be identified on plain abdominal radiographs. [4] The worms may be seen in barium studies in adults (who are often symptom-less) as single or multiple smooth longitudinal or coiled filling defects, sometimes with a thin central track of barium outlining the worm’s intestinal tract.

Occasionally, the adult Ascaris worm may migrate into the Vater’s ampulla and enter the bile duct, gall bladder or pancreatic duct, leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis.

Although the prevalence, diagnosis, and subsequent treatment of an acute abdomen secondary to Ascaris lumbricoides infestation is commonly seen in developing countries, clinicians in developed countries may not consider this entity when faced with a patient with similar symptoms. Recognizing features of parasitic infection is important to establish an early diagnosis that leads to prompt treatment and helps avoid unnecessary surgery. [1] Physicians should have a high index of suspicion for parasitic infestation in warm climates where economically deprived children present with symptoms of intestinal obstruction. [5]

References

 

1. Schulze SM, Chokshi RJ, Edavettal M, Tarasov E. Acute abdomen secondary to ascaris lumbricoides infestation of the small bowel. Am Surg 2005;71:505-7.
2. Park MS, Kim KW, Ha HK, Lee DH. Intestinal parasitic infection. Abdom Imaging 2008;33:166-71.
3. Das CJ, Kumar J, Debnath J, Chaudhry A. Imaging of ascariasis. Australas Radiol 2007;51:500-6.
4. Ellman BA, Wynne JM, Freeman A. Intestinal ascariasis: New plain film features. AJR Am J Roentgenol 1980;135:37-42.
5. Vilamizar E, Mendez M, Bonilla E, Varon H, de Onatra S. Ascaris lumbricoides infestation as a cause of intestinal obstruction in children: Experience with 87 cases. J Pediatr Surg 1996;31:201-4.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.76184

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