Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report

Abstract

Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

Keywords: Ascaris lumbricoides; gangrene; infarction; lymph nodes.

Figure 1. Fig. 1a shows the gross appearance of the gangrenous small bowel loops adjacent to the viable bowel loops after laporotomy, about 25 cm in length upto approximately 15 cm proximal to the ileo ceacal junction.

Fig. 1b shows milking of the proximal bowel being done following resection, which revealed both live and dead roundworms. Resection was done till the healthy bowel end denoted by bleeding from the cut bowel ends. Fig. 1c shows the whole resected gangrenous segment of small bowel along with the dead and alive roundworms milched from both the proximal and the distal ends of the bowel during laporotomy.

Figure 2. Fig. 2a shows extensive transmural haemorrhagic infarct of the intestinal wall with the underlying connective tissue layer, including muscularis showing an intense infiltration of neutrophils.

Fig. 2b shows sections showing mesenteric fat with thrombosed blood vessels. Fig. 2c depicts the intestinal wall with the connective tissue below the muscularis showing oedema, fibrin deposits and eosinophilic infiltrate.

Figure 3. Fig. 3a shows sections showing massively infarcted mesenteric lymph nodes with only a narrow peripheral rim of spared cortical tissue with lymphocytes. Almost the whole nodal parenchyma is necrotic, strongly eosinophilic with ghosts of lymphocytes and of other tissue components. The reticulin network is preserved. In the perinodal fibroadipose tissue, is an abundant inflammatory exudate composed of fibrin and polymorphonuclear leukocytes.

Fig. 3b shows the presence of infarction of only the germinal centre. This probably can be explained by the centripetal nature of the anatomical blood supply of the mesenteric lymph nodes [1].