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
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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
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