Hookworm Infection Caused Acute Intestinal Bleeding Diagnosed by Capsule: A Case Report and Literature Review

Abstract

Hookworm infections are rare causes of acute gastrointestinal bleeding. We report a middle aged man with primary nephrotic syndrome and pulmonary embolism. During the treatment with steroids and anticoagulants, the patient presented acute massive hemorrhage of the gastrointestinal tract. The results of gastroscopy showed red worms in the duodenum. Colonoscopy and CT angiogram of abdomen were unremarkable. Capsule endoscopy revealed fresh blood and multiple hookworms in the jejunum and ileum. Hookworms caused the acute intestinal bleeding. The patient responded well to albendazole. Hematochezia was markedly ameliorated after eliminating the parasites. Hence, hookworm infection should be considered in the differential diagnosis of a patient with obscure gastrointestinal bleeding. Capsule endoscopy may offer a better means of diagnosis for intestinal hookworm infections.

Keywords: Ancylostoma duodenale; Necator americanus; acute intestinal bleeding; capsule endoscopy; hookworm; nephrotic syndrome; pulmonary embolism.

Fig. 1

CT angiogram showing multiple pulmonary embolism.

Fig. 2

Gastroscopy showing red worms swimming in the duodenum.

Fig. 3

Capsule endoscopy identified hookworms in the patient’s intestine.

Fig. 4

Another capsule endoscopy identified a hookworm (arrow) in the patient’s intestine.

Fig. 5

CT angiogram after 6 months showing multiple pulmonary embolism recovered.