Thanks to Dr. Coquillon for today’s Morning Report!
Ascaris-induced intestinal obstruction
Ascaris lumbricoides:
- Most common helminth (roundworm) infection in the world; usually in tropical countries with warm, wet climates
- Length: 1mm to 1m
- Occur in all age groups yet most common in children of preschool age (2-10)
- Transmitted through contaminated food and untreated water.
- Distribution: 73% Asia, 12% Africa, 8% South America
Causes:
- Swallow eggs —> bloodstream to lungs —> return to stomach and small intestine —> lay eggs, excreted in feces
- 49%-90% worms eventually migrate to biliary system
- reported to cause pancreatitis, small intestinal obstruction, intestinal volvulus and intussusception.
Presentation:
- Coughing/gagging/wheezing
- Vomiting roundworm, bilious vomiting
- Irregular stool (slimy)
- Abdominal pain/rigidity
- Weight loss
- Rarely, fever present
Diagnosis:
- Travel history
- Prior treatment for parasitic infection
- Ultrasound – ‘Railway track’ or bull’s eye sign
Treatment:
- Albendazole 400 mg one dose (drug of choice)
- Mebendazole 100mg bid for 3 days or 500mg single dose
- *Ivermectin – paralyzing vermifuge, should be avoided in patient with complete or partial obstruction; may complicate surgery
- Surgical care recommended if:
- Rectal bleeding, signs of obstruction on xray/ct, unsatisfactory response to conservative therapy, appendicitis, hepatobiliary disease, pancreatic pseudocyst
- ERCP can be used to remove warm from biliary system
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
The following two tabs change content below.
Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
Latest posts by Jay Khadpe MD (see all)
- Morning Report: 7/30/2015 - July 30, 2015
- Morning Report: 7/28/2015 - July 28, 2015
- IN THE STRETCHER INSTEAD OF BESIDE IT - July 22, 2015
- Morning Report: 7/14/2015 - July 14, 2015
- Morning Report: 7/10/2015 - July 10, 2015