Molla Yohannis Derbew, Beza Andinet Desalegn, Tadesse Amanuel Kassa, Answar Isak Omer
Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia.
Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia.
Int J Surg Case Rep. 2023 Apr;105:108097. doi: 10.1016/j.ijscr.2023.108097. Epub 2023 Apr 1.
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.
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.
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.
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.
蛔虫病是由蛔虫引起的一种人体蠕虫感染。感染蛔虫的儿科患者可能会出现多种并发症，包括阑尾炎、胃肠道出血、胆管炎或阻塞性黄疸等肝胆疾病、肠套叠和肠梗阻等。即使在流行地区，蛔虫也是肠道穿孔的罕见原因。
一名2岁埃塞俄比亚女童，主诉非胆汁性、非喷射性呕吐，持续6天，每天约两到三次。与此相关的是，她出现了进行性腹胀、间歇性腹痛和食欲不振。检查时，她看起来病得很重。有脱水迹象。随后，她接受了复苏治疗，开始使用广谱抗生素并进行了手术。最终，患儿住院7天后出院，病情有所好转。
蛔虫病的临床表现从无症状儿童到像我们的患者这样需要手术干预的严重疾病患者各不相同。疾病的严重程度取决于虫负荷；大量蛔虫感染会产生一系列急性腹部并发症，如肠梗阻、肠套叠、胆管肝炎、胰腺炎和急性阑尾炎。肠道蛔虫病很少引起肠扭转、肠坏疽、穿孔和腹膜炎。
对于出现腹膜炎的患者，尤其是那些生活在温带和热带国家或有排虫史的患者，在鉴别诊断中必须考虑蛔虫病。蛔虫病患者由于蛔虫直接压迫肠壁、炎症反应或肠扭转及肠壁坏死，可能会发生回肠穿孔。
