Intestinal perforation in ascariasis--case reports

Ascaris lumbricoides a rare cause ileal perforation, a case report

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.

Granulomatous peritonitis by ascaris

The granulomatous peritonitis by ascaris (GPA) is a rare complication of intestinal ascariasis due to the perforation of the digestive tract by the adult worm, which deposits its ova in free peritoneum; therefore, provoking an intense granulomatous inflammatory reaction. We report a case of an 8-year-old boy with GPA, emphasizing the clinical and diagnostical aspects and the therapeutics procedures.

Intraperitoneal ascariasis

Seven children with intraperitoneal ascariasis are reported. One of them had two episodes. There were four instances of free worms in the peritoneal cavity, whereas others had peritoneal abscesses containing round worms. It is suggested that peritoneal ascariasis should be suspected whenever a child presents with peritonitis and/or an inflammatory abdominal mass having evidence of ascarial infestation.

Granulomatous peritonitis due to Ascaris lumbricoides

A child with granulomatous peritonitis caused by ascariasis is described. Laparotomy revealed no obvious evidence of intestinal perforation. It is postulated that a worm escaped through the appendicular tip, causing transient peritonitis followed by adhesions and granulomatas in the peritoneal cavity.

A survey of parasites in primary school children in Dominica, West Indies

A study of Dominican school children aged four to twelve years showed that infection with gastrointestinal parasites was very common. Trichuris was found in the stools in 92% of the children, Ascaris in 38%, Necator in 11%, Giardia in 18% and E. histolytica in 1%. In spite of the high prevalence of parasites, the general health of the children studied was remarkably good, and only 18 of the 1000 children were found to have a haemoglobin level below 10 g/dl.