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CLINICAL IMAGE
Year : 2020  |  Volume : 1  |  Issue : 2  |  Page : 128

Ascariasis and Intestinal Obstruction: Pre-operative hints!


Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission27-May-2020
Date of Decision27-May-2020
Date of Acceptance16-Jun-2020
Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Enono Yhoshu
6th Floor A Block, Department of Pediatric Surgery, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh - 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_47_20

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How to cite this article:
Shasheendran S, Yhoshu E, Chaudhary G, Gupta MK. Ascariasis and Intestinal Obstruction: Pre-operative hints!. J Med Evid 2020;1:128

How to cite this URL:
Shasheendran S, Yhoshu E, Chaudhary G, Gupta MK. Ascariasis and Intestinal Obstruction: Pre-operative hints!. J Med Evid [serial online] 2020 [cited 2021 Apr 13];1:128. Available from: http://www.journaljme.org/text.asp?2020/1/2/128/303572



A 4-year-old boy with acute intestinal obstruction, worms in vomitus and history of pica presented in a sick condition – toxic, pale and dehydrated. The total leucocyte count was 2000 cells/mm3 (n = 5000–15,500) and haemoglobin = 8.8 g/dl (n = 11.5–13.5). X-ray abdomen (AXR) showed dilated bowel loops with multiple air-fluid levels (>5) and some curvilinear opacities in the bowel lumen [Figure 1]. He was resuscitated, and on exploratory laparotomy, a gangrenous segment of distal ileum loaded with roundworms was found. Gangrenous segment was resected and ileostomy was created. Postoperatively, he was managed aggressively, but he expired on post-operative day 3 due to septic shock.
Figure 1: X-ray abdomen showing curvilinear opacities suggestive of worms (white arrow)

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Intestinal obstruction due to Ascaris can be suggested by several clues in history, i.e., worm in vomitus or stool and AXR, wherein the individual worm may be seen as opacity against the bowel gas lying longitudinally or transversely, and clumps of worms may be seen as opacities as in our case, or as 'cigar bundles' or 'whirlpool appearance'.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




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