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Siviero I, de Almeida UVB, Penna CRR, Di Puglia EBM, Simões BCB. Abdominal complications of ascariasis in childhood. J Pediatr (Rio J) 2024:S0021-7557(24)00027-5. [PMID: 38522478 DOI: 10.1016/j.jped.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
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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Affiliation(s)
- Ivonete Siviero
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Cirurgia, Rio de Janeiro, RJ, Brazil.
| | - Ugo V B de Almeida
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Claudia R R Penna
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Elazir B M Di Puglia
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Betina C Bertrand Simões
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Cirurgia, Rio de Janeiro, RJ, Brazil
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Amsalu A, Molla Y. Gallbladder Perforation with Choledochogastric Fistula Due to Ascaris Infestation, a Case Report. Int Med Case Rep J 2023; 16:443-447. [PMID: 37551359 PMCID: PMC10404425 DOI: 10.2147/imcrj.s421611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
We present a case of a 35-year-old Ethiopian female patient presented with right upper quadrant abdominal pain. Studies suspected gallbladder disease, for which she operated. Intraoperatively, gallbladder perforation with choledochogastric fistula was identified, with Ascaris lumbricoides (AL) worm in the common bile duct. Cholecystectomy was performed; common bile was repaired with T-tube and gastric repair. Patient was discharged 11 days after. On subsequent follow-up at the surgical referral clinic, the patient had no complaints.
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Affiliation(s)
- Ashenafi Amsalu
- Department of Surgery, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Yohannis Molla
- Department of Surgery, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
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Molla YD, Beza AD, Tadesse AK, Answar IO. Ascaris lumbricoides a rare cause ileal perforation, a case report. Int J Surg Case Rep 2023; 105:108097. [PMID: 37015161 PMCID: PMC10112151 DOI: 10.1016/j.ijscr.2023.108097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Ascariasis is a helminthic infection of humans caused by Ascaris lumbricoides. Pediatric patients infected with Ascaris can develop multiple complications including appendicitis, gastrointestinal bleeding, hepatobiliary disease like cholangitis or obstructive jaundice, intussusception, and bowel obstruction among others. Ascaris is a rare cause of intestinal perforation even in endemic areas. CASE PRESENTATION A 2-year-old female Ethiopian toddler who was presented with a complaint of non-bilious, non-projectile vomiting of 06 days duration, about two-three episodes per day. Associated with this she had had progressive abdominal distension, intermittent abdominal cramps and loss of appetite. On examination, she was acutely sick looking. She had signs of dehydration. Subsequently, she was resuscitated, broad spectrum antibiotic started and operated. Finally, the child was discharged improved after 7 days of hospital stay. CLINICAL DISCUSSION The clinical presentation of ascariasis can vary from asymptomatic child to one with severe disease requiring surgical intervention like our patient. Severity of disease depends on the worm burden; heavy worm infestation produces a wide range of acute abdominal complications such as intestinal obstruction, intussusception, cholangiohepatitis, pancreatitis, and acute appendicitis. Intestinal ascariasis rarely causes volvulus and intestinal gangrene, perforation and peritonitis. CONCLUSION Ascariasis must be considered in the differential diagnosis in patients presented with peritonitis especially those living or from temperate and tropical countries with a history of passage of worms. Ileum perforation is possible in patients with ascariasis due to pressing directly into the bowel wall, inflammatory reaction, or volvulus and intestinal wall necrosis.
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Affiliation(s)
- Yohannis Derbew Molla
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia.
| | - Andinet Desalegn Beza
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia
| | - Amanuel Kassa Tadesse
- Department of Pathology, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia
| | - Isak Omer Answar
- Department of Pathology, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia
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Ketsekioulafis I, Serpetsidaki E, Tribonias G, Vezakis A, Myoteri D. Granulomatous Peritonitis Secondary to Primary Sclerosing Cholangitis. Cureus 2023; 15:e34738. [PMID: 36909068 PMCID: PMC9997732 DOI: 10.7759/cureus.34738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Primary sclerosing cholangitis (PSC) is a rare, chronic, and progressive disease of the liver characterized by cholestasis due to multifocal bile duct strictures. PSC can lead to liver fibrosis, and in 10-20% of cases, it leads to cholangiocarcinoma and end-stage liver disease. However, the pathogenesis of the disease is not clearly understood. For the diagnosis of PSC, both imaging and liver biopsy can be used. No medical treatment has managed to prevent the progression of the disease. Consequently, in the case of late-stage disease, liver transplantation is considered the best treatment option. PSC may lead to different complications including bacterial cholangitis, cholangiocarcinoma, and cirrhosis. Nevertheless, to our knowledge, there are no reports of granulomatous peritonitis secondary to PSC. Granulomatous peritonitis may be a result of infectious, malignant, and idiopathic inflammatory diseases. It is also considered a rare postoperative complication, due to cornstarch from surgical glove powder, in laparoscopic procedures. Here, we report the case of a 39-year-old male patient with PSC, in which cholangiocarcinoma and peritoneal carcinomatosis were clinically suspected. Despite that, histological findings and staining methods of the surgically removed peritoneal masses demonstrated granulomatous peritonitis.
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Affiliation(s)
- Ioannis Ketsekioulafis
- Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Aretaieion University Hospital, Athens, GRC
| | | | - Georgios Tribonias
- Department of Gastroenterology, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Athens, GRC
| | - Antonios Vezakis
- Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Aretaieion University Hospital, Athens, GRC
| | - Despoina Myoteri
- Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Aretaieion University Hospital, Athens, GRC
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Large Thoracic Lymphadenopathy and Pulmonary Nodules in Young Man. Chest 2022; 161:e169-e173. [DOI: 10.1016/j.chest.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/11/2021] [Accepted: 10/02/2021] [Indexed: 11/18/2022] Open
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Souza AMDES, Barbuto TM, Freitas FA, Vianna NF, Zanchetta CMC, Forsait S, Borba C, Azambuja AMPD, Cristofani LM, Odone V. An unusual abdominal wall mass in a child. Rev Inst Med Trop Sao Paulo 2017; 59:e16. [PMID: 28423091 PMCID: PMC5398188 DOI: 10.1590/s1678-9946201759016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/14/2017] [Indexed: 11/22/2022] Open
Abstract
Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.
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Affiliation(s)
- Amalia Maria do Espirito Santo Souza
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Tomas Marzagão Barbuto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Flávia Alessandra Freitas
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Nathalia Fernandes Vianna
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Carla Maria Costa Zanchetta
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Silvana Forsait
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Claudio Borba
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Alessandra Milani Prandini de Azambuja
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Lilian Maria Cristofani
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Vicente Odone
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
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Abstract
Ascaris lumbricoides, the most frequent human intestinal nematode, is the causative agent of ascariasis, with an estimated worldwide prevalence of over one billion people, especially in moist tropical and subtropical regions, but also in cooler climates. Although characterised with low morbidity and mortality rates, the global prevalence of ascariasis still results in approximately 20,000 deaths annually, primarily as a consequence of intestinal obstruction. In humans, transmission usually occurs by hand-to-mouth route by way of contaminated agricultural products and food, or from dirty hands. Three phases of ascariasis may be present, namely, the pulmonary, intestinal and the complications stage. Although generally asymptomatic, heavy infestation may cause serious pulmonary disease, or partial or complete obstruction of biliary or intestinal tracts. Anthelminthic chemotherapy is required to eradicate the parasites and prevent potentially serious complications. Mebendazole, albendazole and pyrantel pamoate are the most widely used agents to treat ascariasis. Preventive chemotherapy delivered to communities in endemic regions may serve as an affordable and cost-effective strategy to reduce the prevalence and morbidity in endemic regions. Under unusual circumstances, Ascaris suum, the cause of helminthic infection in pigs, may also cause disease in humans.
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Affiliation(s)
- V St Georgiev
- National Institute of Allergy and Infectious Diseases, NIH 6700-B Rockledge Drive, Room 2102, Bethesda, MD 20892, USA.
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Villamizar E, Méndez 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; discussion 204-5. [PMID: 8632280 DOI: 10.1016/s0022-3468(96)90348-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE The purpose of this study is to describe the occurrence and management of bowel obstruction caused by Ascaris lumbricoides, a common parasite in warm climates that affects children with limited socioeconomic means. METHODS Eighty-seven patients with intestinal infestation owing to Ascaris lumbricoides were treated in the past 10 years (1984-1994). There were 48 (55.2%) girls and 39 (44.8%) boys. The mean age was 4.6 years, with peak occurrence at 2 years of age. Half the patients had a history of passing worms by mouth or anus. The majority of patients, 64 (73.5%), presented with a subacute clinical course; 23 (26.5%) had acute presentation, with severe abdominal pain, fever, dehydratation, vomiting, and abdominal distension and required vigorous fluid resuscitation and emergency surgical intervention. Diagnosis was achieved with plain abdominal roentgenograms, which showed a "whirlpool" pattern of intraluminal worms in most cases. RESULTS Six patients had been incorrectly diagnosed as having appendicitis; two cases had appendicitis owing to Ascaris in the cecum and distal ileum. The majority of cases with a subacute presentation respond to medical (anthelmintic) management using oral administration of racine oil and piperazine. Of the 23 patients taken to the operating room, 11 required external "milking" of the obstructing bolus of worms from the ileum into the colon, six required intestinal resection and end-to-end anastomosis, six had an appendectomy, and three needed an enterotomy to manually extract the worms. In one case, initial management consisted of an ileostomy because of intraoperative instability owing to sepsis. Subsequently, after stabilization and treatment with anthelmintic agents, closure of the stoma with an end-to-end ileocolostomy was performed. There was no significant postoperative morbidity or mortality. CONCLUSION These observations suggest that physicians should have a high index of suspicion for parasitic infestation in warm climates where economically deprived children present with symptoms of intestinal obstruction. Ascaris lumbricoides may be the cause of these events in endemic areas. Oral piperazine and racine oil can successfully resolve most subacute cases; however, aggressive resuscitation and prompt surgical intervention in patients with intestinal obstruction result in a satisfactory outcome.
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Affiliation(s)
- E Villamizar
- Department of Surgery, Universidad Nacional de Colombia, Hospital de La Misericordia, Santafé de Bogotá, Colombia
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Taylor KL. Ascariasis of the kidney. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:609-15. [PMID: 8597847 DOI: 10.3109/15513819509026996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The very rare occurrence of ascariasis of the kidney is reported in a 6-year-old boy from Cape Town, South Africa. He was acutely ill with pyonephrosis and passed adult Ascaris lumbricoides per urethra before having a nephrectomy. There was no evidence of a fistula between the intestines and the urinary system, and as the development of larvae into mature helminths within the renal system is not considered to be possible it is likely that mature worms gained entrance through the urethra. It appears that the worms obstructed the right ureter and caused hydronephrosis, pyonephrosis, and deposition of ova in renal tissue.
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Affiliation(s)
- K L Taylor
- Department of Anatomical Pathology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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