Intestinal ascariasis: the commonest cause of bowel obstruction in children at a tertiary care center in Kashmir

Abstract

Background: Ascariasis is the commonest intestinal nematodal infestation in man. Ascariasis commonly inhabits small bowel although it can migrate to biliary tree and other orifices. The aim of this study is to analyze the presentation, diagnosis, management of bowel obstruction caused by Ascaris lumbricoides and to study various surgical complications.

Materials and methods: All patients, 3-14 years of age, who attended the emergency department with diagnosis of intestinal obstruction were screened. Out of these patients with diagnosis of ascariasis based on history of passage of worms per mouth or rectum, X-ray or ultrasonography were followed for a minimum of 6 months. Data regarding the type of management, operative findings, operative procedure and post-operative complications were noted.

Result: Out of 207 patients who were admitted with the diagnosis of intestinal obstruction, 131 were diagnosed as having obstruction due to ascariasis. Most of the patients were 3-5 years of age. Males and females were equally affected. 64 patients needed an operative intervention. Enterotomy was the commonest procedure followed by milking of worms and resection anastomosis. Appendicular perforation was seen in four and worm in gall bladder in one patient. Surgical complications were wound infection in 17, burst abdomen in four and fecal fistula in three patients.

Conclusion: Round worm obstruction should be considered as the first differential diagnosis in any patient of intestinal obstruction in an endemic area like ours. Although most cases are managed conservatively, many patients still need surgical intervention. Efforts should be made toward eradication of this disease by proper sanitation, hygiene and the use of antihelminthics.