Intestinal Intussusception Due to Entrapped Ascaris lumbricoides in a 13-Year-Old Male Patient

Abstract

Ascaris lumbricoides is a fairly common intestinal nematode affecting children worldwide, leading to major medical and surgical complications. Although most of the cases are asymptomatic, heavy infestation causes various acute abdominal complications. Ascaris-induced intestinal intussusception is one of the rare presentations.We report a case of a 13-year-old boy with Ascaris lumbricoides infestation presenting with ileocolic intussusception. The patient presented to the emergency unit with colicky abdominal pain, vomiting, and constipation for two days. He was sick-looking and dehydrated. Further examination revealed diffuse abdominal distension with tenderness, guarding, and palpable mass in the right lower quadrant. Ultrasonography showed long-segment ileocolic intussusception with several worms in the intestinal lumen and adjacent mesenteric lymphadenopathy. An exploratory laparotomy was performed, which revealed ileocolic intussusception. The telescopic loop of the ileum was found to be gangrenous and was resected, and a loop ileostomy was performed. The patient was discharged on the seventh day postoperatively without any complications.Physicians in tropical and subtropical countries should consider this condition in the differential diagnosis when they encounter similar presentations in their clinical practice. Sonography is a non-invasive, easy-touse, and widely available imaging modality that can be employed to diagnose entrapped Ascaris in cases presenting with acute gastrointestinal complications. Early diagnosis and prompt surgical intervention can prevent bowel ischemia/gangrene and significantly reduce morbidity and mortality associated with such cases.

When Diagnosis Curls a Little: Partial Bowel Obstruction Due to Ascaris. L in a Young Man

“…In the transverse cut, a targetoid appearance (also bull's eye) comprising two enucleated circles is seen. 24 …”

“…In obstruction with a low risk of progression to ischemia, conservative management like a nasogastric tube, fluid resuscitation, and gram-negative supporting antibiotics should be considered. 24 …”

“…Ascaris lumbricoides is a common helminth infection in developing countries, particularly in Southeast Asia. 1 , 2 However, due to climate change, increased transport convenience, and immigration from low-income countries, these infections can now occur in countries where they were previously rare. 3 Ascaris infection primarily affects children and can cause malnourishment and growth failure.…”

“…5 , 6 Intestinal obstruction caused by Ascaris should be considered a potential diagnosis for patients with potential risk factors, such as poor hygiene or a history of travel to endemic places. 1 …”

Laboratory diagnosis of Ascaris lumbricoides infestation in paediatric population in two municipalities in Bosnia and Herzegovina

“…Transmission occurs through the fecal-oral route, with risk factors including inadequate personal hygiene and sanitation, warm climates, and high humidity (5). Most individuals with intestinal ascariasis are asymptomatic.…”