Gangrenous small bowel volvulus due to ascariasis in a 9-year-old female: A case report

Abstract

Introduction

While ascariasis is typically asymptomatic or presents with mild gastrointestinal symptoms, it can lead to severe complications, such as intestinal obstruction and volvulus, particularly in children with a high worm burden.

Case presentation

A 9-year-old girl presented to the pediatric emergency department with four days of central abdominal pain, repeated bilious vomiting containing worms, increasing abdominal distension, constipation, and a low-grade fever. She was taken to the operating room for an exploratory laparotomy for suspected bowel obstruction. Intraoperatively, 300 mL of pus was found in the peritoneal cavity, along with a 360-degree gangrenous volvulus of small bowel involving most of the small bowel, from 80 cm distal to the ligament of Treitz to 20 cm proximal to the ileocecal valve. Adhesions and fibrin deposits were noted throughout the peritoneum. The purulent fluid was suctioned out, and the ischemic bowel was completely resected. A large burden of Ascaris worms was found in the lumen of the bowel and was completely removed. We did a jejunostomy and an ileal mucous fistula. Postoperatively, the patient received intravenous ceftriaxone, metronidazole, potassium supplements, and maintenance fluids. Due to the high output of the jejunostomy, we decided to take down the jejunostomy shortly after the initial operation. The ostomy closure was complicated by an anastomotic leak. We explored her and found a pin hole on the antimesenteric side of the anastomosis. We repaired the leak primarily, but the patient developed a recurrence of the leak shortly thereafter, at which time we decided tore-create the jejunostomy and the mucous fistula. Before we could provide further care, her parents decided to leave the hospital against medical advice. We eventually contacted the parents and learned that she died at another institution 10 days after leaving our hospital. The cause of her death was not disclosed.

Conclusion

Even though intestinal infestations are generally mildly symptomatic, Ascariasis and other parasitic infestations should be included in the differential diagnosis of children who live in endemic areas and develop acute abdominal conditions.