Ascaris lumbricoides infestation as a cause of intestinal obstruction in children: experience with 87 cases.

PURPOSE

The purpose of this study is to describe the occurrence and management of bowel obstruction caused by Ascaris lumbricoides, a common parasite in warm climates that affects children with limited socioeconomic means.

METHODS

Eighty-seven patients with intestinal infestation owing to Ascaris lumbricoides were treated in the past 10 years (1984-1994). There were 48 (55.2%) girls and 39 (44.8%) boys. The mean age was 4.6 years, with peak occurrence at 2 years of age. Half the patients had a history of passing worms by mouth or anus. The majority of patients, 64 (73.5%), presented with a subacute clinical course; 23 (26.5%) had acute presentation, with severe abdominal pain, fever, dehydratation, vomiting, and abdominal distension and required vigorous fluid resuscitation and emergency surgical intervention. Diagnosis was achieved with plain abdominal roentgenograms, which showed a "whirlpool" pattern of intraluminal worms in most cases.

RESULTS

Six patients had been incorrectly diagnosed as having appendicitis; two cases had appendicitis owing to Ascaris in the cecum and distal ileum. The majority of cases with a subacute presentation respond to medical (anthelmintic) management using oral administration of racine oil and piperazine. Of the 23 patients taken to the operating room, 11 required external "milking" of the obstructing bolus of worms from the ileum into the colon, six required intestinal resection and end-to-end anastomosis, six had an appendectomy, and three needed an enterotomy to manually extract the worms. In one case, initial management consisted of an ileostomy because of intraoperative instability owing to sepsis. Subsequently, after stabilization and treatment with anthelmintic agents, closure of the stoma with an end-to-end ileocolostomy was performed. There was no significant postoperative morbidity or mortality.

CONCLUSION

These observations suggest that physicians should have a high index of suspicion for parasitic infestation in warm climates where economically deprived children present with symptoms of intestinal obstruction. Ascaris lumbricoides may be the cause of these events in endemic areas. Oral piperazine and racine oil can successfully resolve most subacute cases; however, aggressive resuscitation and prompt surgical intervention in patients with intestinal obstruction result in a satisfactory outcome.