Ascaris lumbricoides and its almost deadly complication

Abstract

Parasitic infections are still a burden in developing countries. The lack of sanitation and hygiene measures can result in an increase in morbidity and mortality due to parasitic infections. Surgery may be needed to treat serious complications caused by some of these parasites. Ascaris lumbricoides is one of the most common parasites and although infections are usually mild, severe complications, although rare, still exist. We present a case of a patient from the Ecuadorean Amazon region with limited access to drinking water. She presented to the emergency room with abdominal pain and a mass in the abdomen. After surgery, a mass with a perforation due to Ascaris was discovered. After discharge and due to lack of follow up and self-care, she became infected again, this time making her prognosis more complex and her clinical presentation more difficult. However, after proper clinical and surgical management, patient fully recovered.

Figure 1:

(A) CT revealing a mass in the colon that invaded the small bowel mesentery. (B) Colonic mass, with a cavity filled with fluid and gas. (C) Colonic mass and jejunum, colon with multiple ischemic and necrotic patches.

Figure 2:

(A) Microscopic view of necrosis in the colonic wall. (B) Microscopic view of the inflammatory reaction in the jejunum wall. (C) Inflammatory colonic mass that compromised the jejunum with the two Ascaris.

Figure 3:

(A) Female worms with multiples eggs in its uterine tubule. (B) Re-laparotomy with the enterocutaneous fistula managed like an ostomy. (C) Follow-up control, with adequate fistula management.