Intestinal Intussusception Due to Entrapped Ascaris lumbricoides in a 13-Year-Old Male Patient

Abstract

Ascaris lumbricoides is a fairly common intestinal nematode affecting children worldwide, leading to major medical and surgical complications. Although most of the cases are asymptomatic, heavy infestation causes various acute abdominal complications. Ascaris-induced intestinal intussusception is one of the rare presentations. We report a case of a 13-year-old boy with Ascaris lumbricoides infestation presenting with ileocolic intussusception. The patient presented to the emergency unit with colicky abdominal pain, vomiting, and constipation for two days. He was sick-looking and dehydrated. Further examination revealed diffuse abdominal distension with tenderness, guarding, and palpable mass in the right lower quadrant. Ultrasonography showed long-segment ileocolic intussusception with several worms in the intestinal lumen and adjacent mesenteric lymphadenopathy. An exploratory laparotomy was performed, which revealed ileocolic intussusception. The telescopic loop of the ileum was found to be gangrenous and was resected, and a loop ileostomy was performed. The patient was discharged on the seventh day postoperatively without any complications. Physicians in tropical and subtropical countries should consider this condition in the differential diagnosis when they encounter similar presentations in their clinical practice. Sonography is a non-invasive, easy-to-use, and widely available imaging modality that can be employed to diagnose entrapped Ascaris in cases presenting with acute gastrointestinal complications. Early diagnosis and prompt surgical intervention can prevent bowel ischemia/gangrene and significantly reduce morbidity and mortality associated with such cases.

Keywords: ascaris lumbricoides; ileocolic; intestinal obstruction; intussusception; ultrasonography.

Figure 1. High-resolution transverse sonography of the abdomen via a linear transducer placed in the right iliac fossa region

The image shows a swirled pattern of alternating hyperechogenicity and hypoechogenicity giving the classical "target" appearance representing the alternating layers of mucosa, muscularis, and serosa. Findings are consistent with intussusception with the inner bowel (black arrow) representing the intussuscipiens and the outer bowel (white arrow) representing the intussusceptum

Figure 2. High-resolution sonographic view with a linear transducer placed in the right iliac fossa region in the longitudinal plane

The image shows the telescoping of a segment of the small bowel loop (black arrow) into the large bowel (white arrow), suggestive of intussusception

Figure 3. Proximal to the site of intussusception; the image shows a tubular hypoechoic structure with parallel echogenic lines in the dilated proximal bowel loop representing the characteristic appearance of an intestinal worm (white arrow)

Figure 4. Multiple, rounded, and enlarged hypoechoic lymph nodes (black arrow) in adjacent mesentery suggestive of lymphadenopathy; however, no necrosis, calcification, or conglomeration was seen

Figure 5. Intraoperative image showing the terminal ileum, appendix, and ileocolic junction

Figure 6. View of extracted Ascaris worms