Intestinal Helminths Infections as Infrequent Cause of Emergency Abdominal Surgery: A Retrospective Study in a University Hospital over 20 Years

INTRODUCTION

All organs of any organism can be affected by helminths. They can be seen in a broad spectrum, from simple infestations to extensive, life-threatening involvement. Symptomatology is usually of chronic latent course. However, sometimes the presentation is acute and requires urgent surgical intervention.

MATERIAL AND METHODS

We conducted a retrospective observational prospective recruitment study of patients undergoing emergency surgery for helminth infection from January 2000 to December 2019 at a university hospital. Sociodemographic and analytical variables, variables related to the clinical process, and the diagnostic test were analysed. Variables related to the surgical procedure and postoperative complications were also analysed.

RESULTS

A total of 36 patients required emergency surgery for their helminth infection, which represented 0.26% of emergency abdominal surgeries. The mean age was 34.91 ± 21.5 years, with a predominance of men (69.4%). Most patients presented with pain in the right iliac fossa (69.4%), followed by symptoms compatible with intestinal obstruction (19.4%). The most frequent surgical interventions were appendectomy (38.9%) followed bowel resection (33.3%) and ileocecal resection (11.1%). Enterobious vermicularis and Anisakis simplex both together accounted for 75% of the sample. Statistically significant differences were identified in age (p < 0.001), diagnostic test performed (p = 0.032), intraoperative clinical diagnosis (p = 0.005) and surgical treatment received (p < 0.001).

CONCLUSION

The frequency of emergency surgeries for intestinal helminth parasitism is decreasing. However, the majority of these are E. vermicularis and Anisakis simplex, which have distinctly different clinical presentations. Identification and recognition by physicians continue to be necessary for further postoperative management and possible complications.

Parasitic infestation in appendicitis. A retrospective analysis of 660 patients and brief literature review

OBJECTIVES

To investigate the incidence of parasitic infestations and inflammation accompanying parasitosis in a series of appendectomy cases.  Methods: Six-hundred-sixty  patients who had undergone appendectomy in Bingöl State Hospital, Bingol, Turkey with the preliminary diagnosis of appendicitis between January 2012 and February 2015 were included in this retrospective study. They were retrospectively evaluated in terms of age, gender and pathological findings. Cases diagnosed with parasitic infestations were re-evaluated histopathologically for inflammatory response.  Results: The mean age was 19.6 years, and the male/female ratio was 1.8. When evaluated in terms of histopathological diagnoses, 573 (86.8%) were diagnosed as acute appendicitis, and parasitic infestation was identified in 12 (1.8%). Among cases with parasitic infestation, Enterobius vermicularis was identified in 9 (75%) and Taenia in 3 (25%) cases. Of cases with Enterobius vermicularis, 4 (44.4%) had lymphoid hyperplasia, 1 (11.1%) had normal-structured appendix vermiformis, and 4 (44.4%) had findings of acute appendicitis. All cases with taeniasis had an inflammatory response: acute appendicitis was identified in 2 (66%) and acute gangrenous appendicitis in 1 (33%) of them.  Conclusion: Parasitic infestations are among the probable causes in appendicitis etiology and should be kept in mind during differential diagnosis. However, whether every parasitic infestation leads to appendiceal inflammatory response is controversial.

Ileal intussusception due to a parasite egg: A case report

Ileal intussusception is the invagination of the small intestine within itself and accounts for 1% of cases of acute obstruction. However, physicians do not initially consider intussusception as a possible diagnosis of obstruction due to its rarity in adults. Herein, we report the case of a 22-year-old male who was admitted to the Emergency Department with continuous abdominal pain. Ultrasonography and computed tomography revealed an ileal intussusception. The patient underwent surgical removal of the segment of the small bowel. Unexpectedly, pathology revealed that the invagination occurred due to a parasite egg, with features suggestive of Schistosoma species. Schistosomiasis, although considered a parasitic disease in tropical countries, is not absent from Europe and though it is highly improbable, it may be responsible for cases of intussusception in adults.

[Ileocecal ameboma: a case diagnosed by pathology and molecular biology]

Colonic ameboma is a rare benign inflammatory tumor due to the infection by Entamoeba histolytica and poses frequently the problem of colon cancer. We report a case of a 52 year-old patient who presented a cecal amoeboma revealed by a painful mass in the right iliac fossa. Radiologic and endoscopic examinations depicted a parietal thickening of the right colon and the cecum. A presumptive diagnosis of colon cancer was firstly discussed. Confirmation of ameboma was made on pathological examination, PCR and serology.

Traumatic rupture of hydatid cyst with unusual localization without liver involvement: a case report

Primary hydatid disease of the intestinal mesentery is rare. We report on a 12-year-old male patient who presented with abdominal pain and urticaria lesions after blunt abdominal trauma. At laparotomy the cyst was found to be ruptured and was totally removed from the surrounding mesenteric tissue. The postoperative course was uneventful. This case is the first child reported with traumatic rupture of a hydatid cyst in a mesenteric location.

[Pinworm infestation of the appendix]

The Authors present 2 cases of enterobiasis of appendix observed on a total of 186 appendicectomies. Enterobius infestation is an uncommon cause of acute appendicitis. Preoperative diagnosis of pinworm infestation is almost impossible without clinical suspect. Parasites may produce symptoms which resemble acute appendicitis but parasitic infection rarely causes it. It is also important considered in the differential diagnosis cases that mimic Crohn's disease.

Intestinal anisakiasis in Italy: case report

A case of intestinal anisakiasis caused by Anisakis sp. larva type I in a woman from Italy who consumed raw marinated anchovies, is reported. The diagnosis was based on the morphological features characteristic of anisakid larval stages, which were readily recognized in a large granuloma removed after emergency surgical treatment.

Massive gastrointestinal bleeding in infants with ascariasis

Although infestation with Ascaris lumbricoides causes various intestinal complications, massive gastrointestinal bleeding is rare. The authors report on 2 infants who presented with massive hematemesis. In the first patient, a gastroduodenoscopy was performed. Roundworms were found adhering to an oozing duodenal ulcer. Duodenal perforation occurred after extraction of the parasites. The second case was hematemesis together with peritonitis. Exploration found volvulus and a gangrenous segment of the distal ileum. Both infants previously passed roundworms with their stool. The authors conclude that the intestinal ascariasis can be a cause of massive gastrointestinal bleeding, especially in temperate and tropical countries.

Human intestinal anisakiosis due to consumption of raw salmon

Anisakiosis is a parasitic infection that follows consumption of raw or insufficiently pickled, salted, smoked, or cooked wild marine fish infected with Anisakis sp. larvae. We report a case of intestinal anisakiosis in a 50-year-old man from Quebec who presented with abdominal pain and peripheral eosinophilia after eating raw wild-caught salmon from the Pacific Ocean off Canada. Abdominal CT scan showed bowel distension proximal to a segmental jejunal wall thickening, which was resected. The jejunum segment showed a localized area of serositis with mucosal edema and a submucosal abscess rich in eosinophils surrounding a parasite consistent with the third larval stage of Anisakis sp. Diagnostic morphologic characteristics included an unpaired excretory gland (renette cell), Y-shaped lateral epidermal cords, no apparent reproductive system, and a ventriculus (glandular esophagus). These features and the absence of lateral alae excluded Ascaris sp. The absence of ventricular appendage and intestinal cecum excluded other anisakids of the genera Pseudoterranova and Contracaecum. As the popularity of eating raw fish is growing in North America, anisakiosis may be diagnosed more frequently in surgical specimens. This parasitic infection should be considered in the differential diagnosis of acute abdominal syndromes and eosinophilic infiltrates of the stomach, small intestine, colon, omentum, and mesentery, especially with a history of raw marine fish consumption.

[Gastrointestinal anisakiasis. Study of a series of 25 patients]

INTRODUCTION

Infection with the parasite Anisakis simplex is common in Japan and northern European countries. The number of reported cases in Spain has increased since the first description in 1991. The aim of the present study was to evaluate the incidence, clinical patterns, histopathological lesions, treatment, and outcome of Anisakis simplex infection in our environment.

MATERIAL AND METHOD

Cases of gastrointestinal anisakiasis diagnosed in our center from December 1999 to January 2002 were studied. Only patients with detection of the parasite in oral endoscopy or the surgical specimen and those with elevated levels of specific IgE to Anisakis simplex, a clinical picture compatible with anisakiasis, or a history of raw fish intake were included. Epidemiological, clinical and laboratory data, as well as diagnostic, histopathologic and therapeutic features, and outcome in these patients were recorded.

RESULTS

Twenty-five cases of gastrointestinal anisakiasis were diagnosed during the study period, representing an incidence of 3.87 cases per 100 000 inhabitants/year. All the patients had ingested raw anchovies. Two groups were observed. The first group was composed of 10 patients with a gastric form of the infection, in which the main symptom was epigastralgia (90%). Oral endoscopy was performed in all patients and the parasite was detected in five (50%). The second group was composed of 15 patients with intestinal involvement in which the main manifestations were symptoms mimicking appendicitis (80%). The most frequent finding of laparotomy and/or imaging tests (abdominal ultrasonography, intestinal transit, abdominal CAT) was terminal ileitis (80%). Seven patients underwent surgery: intestinal resection was performed in four with detection of Anisakis simplex in three. Eosinophilic infiltration was found in all surgical specimens. Treatment was symptomatic in most of the patients and outcome was favorable in all.

CONCLUSIONS

Infection with Anisakis simplex should be investigated in patients with abdominal pain after intake of raw fish, ileitis of unclear origin, or eosinophilic gastroenteritis.

Unusual intestinal sequelae after operations for Ascaris lumbricoides infestation

Two children with severe bowel sequelae distal to the site of an Ascaris lumbricoides bowel obstruction are reported. It is postulated that these resulted from inflammatory reaction to toxic decomposition products of disintegrating worms. Surgery should be modified in the presence of bowel-wall injury distal to the site of ascarid worm - bolus obstruction.

Small intestinal transections decrease the occurrence of tapeworm-induced myoelectric patterns in the rat

Abstract Luminal infection by the noninvasive tapeworm, H. diminuta, alters rat small intestinal myoelectric activity. The significance of continuity between small intestinal enteric nervous system (ENS) and that of both the stomach/pylorus and colon/caecum regarding the induction of tapeworm-altered myoelectric patterns was evaluated. A total of 32 rats were implanted with four serosal electrodes placed at sites in the duodenum through the mid-jejunum. Sixteen of the 32 rats underwent intestinal transections and anastomoses at both the duodenum and ileum. After recording myoelectrical activity of both normal and transected intestines, eight rats from each group (normal and transected) were infected with H.diminuta. Phase III frequency, duration of the migrating myoelectric complex (MMC), slow wave frequency, percentage of slow waves associated with spike potentials and the occurrence of the the two tapeworm-initiated myoelectric patterns, repetitive bursts of action potentials (RBAP) and sustained spike potentials (SSP), were measured. In infected rats, the frequency of the RBAP and SSP electric patterns were significantly reduced by the double transection. Intestinal transection did not affect the other changes caused by infection, such as decreased MMC phase III frequency and percentage of slow waves associated with spike potentials. In conclusion, a small intestinal ENS in continuity with other segments of the GI tract is required to generate maximal numbers of tapeworm-induced SSP and RBAP myoelectric activity in the small intestine of the rat.

Intestinal regrowth is amplified after jejunal but not ileal resection during tapeworm infection in the rat

The ileum possesses functions required by a healthy individual that are not fully supplanted by the duodenum or jejunum. Evidence suggests that the ileum may also be necessary to maintain an enteric parasite-host interaction. We hypothesized that the ileum is essential to the survival of the lumen-dwelling, rat tapeworm, H. diminuta. Male rats were divided into three groups: those with ileal or jejunal resections and nonresected controls. Half of each rat group was infected with the tapeworm. After jejunal resection, the weight but not length of intestinal remnant (duodenum + ileum) in infected rats returned to that of control, nonresected intestine 29 days after surgery and tapeworm numbers were fully maintained. In contrast, after ileal removal intestinal length and weight of the remaining duodenum and jejunum in infected rats were significantly decreased and tapeworm survival diminished. Data indicates that intestinal growth following resection is amplified by tapeworm infection when the ileum remains but diminished when the ileum is removed. Furthermore, loss of the ileum results in decreased infection intensity and dry weight of the tapeworm.

Clinical appraisal of Ascaris lumbricoides, with special reference to surgical complications

Over a period of 4 years (January 1993-December 1997), 509 patients were treated for abdominal colic with or without intestinal obstruction and a history of passage of adult roundworms either in the stool or in vomitus. All patients were below the age of 10 years, the youngest 6 months old, and were treated successfully with antispasmodics and normal saline enemas. When the pain subsided, an anthelminthic drug was given. Of 209 patients admitted to the hospital, 105 responded to conservative management and 104 (50%) required surgical intervention. The procedures included squeezing out of worms, resection and anastomosis, and treatment of other pathologies like acute appendicitis, tubercular stricture of the small intenstine, etc. Five patients died in the postoperative period due to various complications. There were no deaths among those treated by conservative management. Early recognition of the condition can prevent serious surgical complications and morbidity.

Ultrasound diagnosis of oesophagostomiasis

Human infection with Oesophagostomum bifurcum, a parasitic intestinal helminth, is endemic in parts of West Africa. Oesophagostomum bifurcum juveniles develop in the colonic wall, causing pus-filled granulomas. The pathology has two distinct forms. Multinodular oesophagostomiasis comprises hundreds of small nodules within a thickened, oedematous wall of the large intestine. Uninodular oesophagostomiasis, called the Dapaong tumour, presents as a painful 30-60 mm granulomatous mass in the abdominal wall or within the abdominal cavity. Diagnosis of oesophagostomiasis on clinical grounds alone is difficult. We describe cases illustrating the ultrasound appearance of these two presentations. Multinodular disease shows nodular "target" and "pseudokidney" colonic lesions. The Dapaong tumour is an echo-free ovoid lumen enveloped within a well defined poorly reflective wall.

Cryptic infection by whipworm mimicking a sessile polyp of the colon

A case of trichocephaliasis in a 70-year-old male is described. The original diagnosis, based on radiological and endoscopic findings, was of a sessile polyp of the colon. Only when a fragment of the supposed polyp was removed at biopsy and examined histologically was it revealed as a single male specimen of whipworm.

[Intestinal schistosomiasis, a facultative precancerous condition? Review of the literature with reference to Schistosoma japonicum associated rectum carcinoma]

After a latency period of 20 years, in a 39-year-old Austrian citizen of Chinese origin, a surgically removed rectal carcinoma, as well as the neighboring chronic inflammatory rectal mucosa with various degrees of dysplasia and one positive neighboring lymph node, showed helminthiasis in the histopathological examination, convincing us of a link between carcinoma and chronic helminthiasis. Whereas the etiological context between chronic infection by Schistosoma haematobium and endemic frequent urinary bladder carcinoma is considered a matter of fact, whether of not the incidence of intestinal carcinoma is increased in connection with chronic intestinal schistosomiasis is controversial. The etiological and pathogenetic link between helminthiasis and carcinoma should be considered in the same way as for other related inflammatory large-bowel diseases. In the sequence chronic inflammation-severe dysplasia, the formation of carcinoma could possibly occur. Besides a survey of trematodes parasitology and pathology, the link between rectal carcinoma and Schistosomiasis japonicum is pointed out by means of appropriate literature investigations.

Ileal amoebiasis

Whilst colonic amoebiasis and its complications are well-documented, ileal amoebiasis has not been described in the literature. We report the cases of two patients with ileal amoebiasis and outline their management and outcome. It is important that surgeons working in areas endemic for amoebiasis be mindful of this entity.

Rectosigmoid bilharzioma causing intestinal obstruction

Schistosomiasis is an infection caused by flukes (trematodes) of any species of the genus Schistosoma whereas bilharzioma implies a localized mass of fibrous and inflammatory tissue, which usually contains many eggs, frequently involving serosa and mesentery. Bilharziomas are probably caused by a reaction to numerous eggs produced by one or more pair of worms in a single site, although altered host reactivity may also be a factor. Bilharziomas, even in endemic areas are quite uncommon lesions in adults. So far they have not been reported to cause intestinal obstruction in children. Herein we present a case masquerading as large bowel malignancy in a child. Management and follow up are also mentioned.

Management of intestinal obstruction caused by ascariasis

A retrospective clinical study to evaluate the effects of paralyzing vermifuges on the course of intestinal obstructions complicating ascariasis was performed. Forty-two patients, 26 patients with partial and 16 patients with complete intestinal obstructions, were treated over 7 years. Although 24 patients have not received any medications two patients with partial obstructions received flaccid paralyzing agent before referral. However, 12 of 16 patients with complete obstruction received spastic paralyzing agent, and the remaining patients received flaccid paralyzing agent before referral. Paralyzing agents, especially those causing spastic paralysis, should be avoided in patients with abdominal symptoms presumed to be related to ascariasis because of the risk of causing complete obstruction and making surgery more complex.

Intestinal obstruction due to ascariasis

BACKGROUND

Intestinal obstruction due to ascariasis results from heavy worm infestation. This study is a review of 92 patients with intestinal obstruction from Ascaris lumbricoides.

METHODS

Sixty-eight patients without peritonism were treated conservatively with resuscitation, antibiotics and anthelminthics. The remaining 24 patients presented with abdominal signs suggesting strangulation. Plain abdominal radiography was done in all patients. Abdominal ultrasonography was performed in the last 22 patients.

RESULTS

There were no deaths in the first group and duration of hospital stay ranged from 4 to 7 days. Five of 24 patients in the second group died during resuscitation. After successful resuscitation, 19 had a laparotomy. Six patients needed resection of gangrenous bowel with primary anastomosis, in 11 an enterotomy was used to remove obstructing worms and in two it was possible to milk obstructing worms into the colon. Seven patients died after operation, giving an overall mortality rate of 12 of 24 patients in the second group. The characteristic sonographic features of 'railway track' sign and 'bull's eye' appearance helped make the diagnosis of ascariasis, and ultrasonographic signs were also typical for strangulation in five patients.

CONCLUSION

Early clinical diagnosis supported by ultrasonography, together with prompt surgery when necessary, might reduce the mortality rate in what is still a potentially dangerous condition.

Surgical ascariasis in children in Kashmir

A retrospective study of 85 children aged 3-12 years revealed 25 cases who needed surgical intervention due to ascariasis. The surgical conditions found at laparotomy were intestinal obstruction (18) appendicitis (3), ileal perforation (2), biliary ascariasis (2). The study highlights the high incidence of surgical ascariasis among children with abdominal complaints in an endemic area.

Surgical management of worm volvulus

A retrospective study of 50 consecutive patients with small-bowel volvulus complicating intestinal ascariasis is reported. The commonest presenting features were abdominal distension (44 patients) and abdominal pain (38 patients). Thirty-three patients presented with vomiting, of whom 8 vomited worms. Twenty-five patients presented with peritonitis. In 33 patients there was evidence of worm infestation on radiographs while volvulus was diagnosed radiographically in 16 patients. Thirty-two patients required emergency surgery, while 16 were observed for a mean of 2.6 days before surgery. Thirty-nine patients had gangrenous bowel that required resection. The overall mortality rate was 14.5% and all deaths were from the gangrenous group. The results show that volvulus complicating ascariasis still carries a high mortality and morbidity rate. We stress the importance of early detection and early operative intervention.

[Surgical complications of intestinal ascariasis]

Ascaridiosis is a usually benign disease caused by the parasite Ascaris lumbricoides. Medical treatment is usually sufficient. Prevalence in tropical zones is high, sometimes leading to severe surgical complications requiring treatment and having a high morbidity and mortality. Codified treatments are needed to reduce the incidence of ascaridiosis. Large scale prevention is needed, especially in endemic zones.

Intestinal anisakiasis: first reported case in Thailand

A case of intestinal anisakiasis is reported. The patient came with the symptoms of acute abdominal obstruction. The diagnosis was obtained by identification of the parasite in the tissue sections of the resected segment of the small intestine. This case appears to be the first reported case in Thailand.

[Biliary ascaridiasis]

A case of biliary ascaridiasis is presented in which biliary obstruction and pancreatitis were diagnosed. Recovery followed surgical removal of the worms. The literature is reviewed.

[Ascaris lumbricoides--a cause of acute abdomen]

Ascaris lumbricoides infestation is the most common helminthic disease in many developing countries and may cause severe surgical complications, especially in children. We present a 3-year-old Ethiopian immigrant brought to hospital directly from the airport because of signs of acute abdomen. It was found to be caused by volvulus and necrosis of a loop of bowel impacted with worms. The necrotic bowel loop was resected and a temporary ileostomy was formed; recovery was uneventful. This disease and its severe complications are rare in Israel and the western world. Awareness of its occurrence is important in view of the present world-wide large-scale immigration from developing countries.

Surgical manifestations of ascariasis in childhood

Amongst 50 patients with surgical complications of Ascaris lumbricoides 35 patients (70%) were treated conservatively and 15 patients (30%) required surgical intervention which included squeezing of worms to distal colon, resection and anastomosis of ileum, appendicectomy and peritoneal lavage. Intestinal perforation was observed in 3 cases. Two patients (4%) died because of postoperative complications. Those presenting with subacute intestinal obstruction had no mortality or morbidity. Although a large number of roundworms were seen in the jejunum, the obstruction was generally observed in the distal ileum.

Complications of Ascaris lumbricoides infection: case reports from south western Uganda

Two cases of intestinal obstruction due to Ascaris lumbricoides infection are reported from Ishaka Adventist Hospital, in south western Uganda. One was a male aged two and a half years and another was a female aged twenty. They were both treated surgically with good results. A review of the literature also revealed that intestinal obstruction due to A. lumbricoides is a common complication, though other surgical and nutritional complications also seem to be common, they are less reported.

[Ileus of the small intestine caused by intestinal anisakiasis (herring worm disease)]

Two cases of anisaciasis caused by eating of improperly prepared herrings which were infested with larval nematodes are reported. The acute type with a stenosing process in the small intestinal wall existed in both cases which resulted in an ileus. Therapy was resection of the affected intestinal part with end-to-end-anastomosis. The morphological proof of larval nematodes, which penetrate from lumen into the eosinophilic granulomata, pseudotumours and eosinophilic microabscesses are important histological findings. It should be considered the possibility of a herring worm disease in the case of an acute abdomen caused by an inflammatory small bowel stenosis.

Small bowel volvulus complicating intestinal ascariasis in children

Twenty-nine patients in whom small bowel volvulus complicated intestinal ascariasis are reported. Attention is drawn to the varied clinical and radiological presentation and the relationship of volvulus to the use of vermifuge. The mortality of 17 per cent was contributed to by delay in diagnosis and failure of pre-operative resuscitation. Early diagnosis is dependent upon clinical vigilance and repeated radiological assessment of those patients with simple ascaris obstruction who fail to improve rapidly with conservative treatment. The instillation of intraluminal vermifuge intra-operatively has minimized postoperative worm migration through suture lines and anastomoses.

[A case of abdominal actinomycosis]

A 43-year-old man, with a chief complaint of abdominal pain and a palpable mass in the lower abdomen, was admitted to this hospital. He had 2-3 episodes of diarrhea monthly for several years. Laparotomy revealed the mass resembling sarcoma, invaded the ileum and bladder and also it had disseminated lesions in the other intraabdominal organs. Resected tissues showed actinomycotic abscess. AB-PC was administered post-operatively, with a satisfactory prognosis. On the 71 patients with abdominal actinomycosis who underwent laparotomy during the past 32 years in Japan, 42 were males and 28 females. Many of them were in their forties or fifties. Some literatures mention the ileocecal region as the usual site of following perforated appendicitis. As far as this review is concerned, however, the transverse colon was as frequently affected as the ileocecal region and it was only in 13 patients that acute appendicitis preceded the infection. Abdominal actinomycosis is not an uncommon disease and should be taken into consideration in the differential diagnosis of the abdominal mass.

Appendiceal schistosomiasis. Method of classifying oviposition and inflammation

Twenty surgical specimens of appendiceal schistosomiasis were reviewed retrospectively. They constituted 1 percent of 1984 appendices seen among approximately 15,000 surgical specimens examined at free central laboratories serving the Igbos of Nigeria, West Africa. Oviposition by Schistosoma haematobium was classified according to its association with suppurative appendicitis and normal appendices. Seven of ten infested appendices obtained at curative operations showed suppurative appendicitis, whereas eight of nine infested appendices removed at incidental appendectomies were negative. One interval appendectomy was also negative. It is postulated that utilization of this novel classification on a worldwide basis will help to end the controversy concerning the etiologic role of schistosome ova in acute appendicitis.

[Extensive resection of the small intestine in children]

Thirteen children aged 2 to 16 years have had a subtotal resection of small bowel, following a mid-gut volvulus in 10 cases. All children are still alive, and their growth was normal; 36 cumulative patient-years of parenteral nutrition and 11 years of constant rate enteral nutrition were performed. In 7 cases, where residual small bowel varied between 30 to 120 cm, termination of all artificial nutritional support was possible at a mean of 30 months after intestinal resection. On the other hand if resection was near total with less than 20 cm remaining, life long dependence on parenteral nutrition is unavoidable unless intestinal transplantation becomes feasible; with cyclic parental nutrition at home, their quality of life is near normal.

Colorectal schistosomiasis: clinicopathologic study and management

Forty patients with colorectal schistosomiasis who failed to respond to medical therapy were studied. They had dysentery with bloody mucus and anemia, polyps, pericolic masses, and schistosomal ulcers. Two patients had cecal masses which appeared to be intussusception and appendicitis. Three patients had chronic intestinal obstruction. Diverting transverse colostomy, followed by other surgical procedures, is the safest method of management.