Medrano Jesus Sebastian Luna, Rafael Maylin Abigail Matienzo, Rojas-Arana Carlos, Cuellar Astrid Geraldine Carrión, Mota Moises Miguel Florentino, Merino Paolo Augusto Romero, Villacis Erick
Universidad Nacional José Faustino Sanchez Carrión, Av. Mercedes Indacochea 609, Huacho 15136, Peru.
Universidad Cesar Vallejo, Av. Alfredo Mendiola, 6232, Los Olivos, Peru.
J Surg Case Rep. 2025 Sep 2;2025(9):rjaf647. doi: 10.1093/jscr/rjaf647. eCollection 2025 Sep.
Ascariasis, caused by , is the most common helminthic infection worldwide, mainly in developing countries. Although intestinal obstruction is its most frequent complication, intestinal perforation with peritonitis is rare and life-threatening. A 45-year-old woman from a rural area presented with cramping abdominal pain, intermittent fever, and asthenia for 3 months. Emergency laparotomy revealed generalized peritonitis due to ileal perforation, managed with ileal resection and ileostomy. Postoperative complications included respiratory failure, septic shock, and three reoperations for eventration, adhesive syndrome, and hemorrhage. On postoperative Day 33, a 20 cm worm was expelled through the ileostomy. Intestinal perforation likely resulted from pressure-induced ischemia by a worm mass. Diagnosis can be delayed due to nonspecific symptoms and absent eosinophilia. Ascariasis should be considered in the differential diagnosis of intestinal perforation in endemic areas. Early surgical intervention, clinical suspicion, and preventive measures are key to improving outcomes.
蛔虫病由蛔虫引起，是全球最常见的蠕虫感染，主要发生在发展中国家。虽然肠梗阻是其最常见的并发症，但肠穿孔伴腹膜炎很少见且危及生命。一名来自农村地区的45岁女性出现腹部绞痛、间歇性发热和乏力3个月。急诊剖腹探查发现由于回肠穿孔导致弥漫性腹膜炎，行回肠切除术和回肠造口术治疗。术后并发症包括呼吸衰竭、感染性休克以及因腹疝、粘连综合征和出血进行的三次再次手术。术后第33天，一条20厘米长的蛔虫通过回肠造口排出。肠穿孔可能是由蛔虫团块压迫导致的缺血引起。由于症状不具特异性且无嗜酸性粒细胞增多，诊断可能会延迟。在流行地区，肠穿孔的鉴别诊断中应考虑蛔虫病。早期手术干预、临床怀疑和预防措施是改善预后的关键。
