Small Bowel Obstruction In Children due to Intestinal Ascariasis: Role of conservative management.

Dr. Fayaz Ahmad Najar; Dr. Peer Hilal Ahmad Makhdoomi; Dr. Tajamul Rashid

Volume : IX, Issue : VIII, August - 2020

Small Bowel Obstruction In Children due to Intestinal Ascariasis: Role of conservative management.

Dr. Fayaz Ahmad Najar, Dr. Peer Hilal Ahmad Makhdoomi, Dr. Tajamul Rashid

Abstract :

Background: Ascariasis is an alarming health hazard commonly seen in children of endemic areas. In humans, Ascaris lumicoides can lead to a spectrum of surgical complications; Intestinal obstruction is by far the most common surgical emergency caused by Ascaris lumicoides in children. Eventhough most cases of worm obstruction are managed conservatively, however, surgical intervention is not over ruled absolutely. The purpose of this study was to observe the clinical presentation and out of conservative management of worm obstruction in children. Materials and Methods: All children who presented in surgical emergency with features of worm induced small bowel obstruction were studied from April 2016 to April 2019. A detailed history, clinical examination, plain X–ray of abdomen and ultrasonography of abdomen was done in all patients. Results: In this study a total of 80 patients were observed. There was a male preponderance with a male to female ratio of 3:1. Mean age of patients was 5.35 years (range 2 – 14 years). Age group of 4–8 years (90%) was commonest group affected. Majority of the patients (n = 64, 80%) presented within 2–4 days of duration of illness. Abdominal pain was the leading symptom in 75 patients (93.75%) with the pain in periumbilical area present in 48 patients (60%). Vomiting and constipation were the other two common presenting features; however, 30 patients had history of passage of worms either with vomitus or with stools. In 52 patients (65%) abdominal distension was seen and was the commonest physical finding. Palpable worm masses were seen in 20 patients (25%). None of the patients had history of bleeding PR on presentation. On X–ray of abdomen, visible worm masses were seen in 16 patients (20%). Abdominal ultra–sonography showed interloop fluid in 25 patients (31.25%) and free fluid in the pelvis of 16 patients (20%). The number of patients who were managed conservatively was 72 (90%), and 8 patients (10%) had surgical intervention because they developed and/or persisted with features of peritonitis. In patients who had surgical intervention, 5 patients (6.25%) had enterotomy, resection anastomosis in 1 patient (1.25%) and 2 patients (2.5%) had kneading of worms. Postoperative complication of enterocutaneous fistula occurred in 1 patients and an overall mortality was nil. Conclusions: Worm obstruction is one of the commonest causes of intestinal obstruction in children. Abdominal pain is the leading symptom of worm obstruction with abdominal distension as most common physical finding. Plain X–ray and ultrasonography of the abdomen are used to diagnosis worm obstruction. The majority of the patients can be managed conservatively without any complication, however, surgical intervention may be needed in some cases.