Current Pediatric Research

Introduction: Ascaris lumbricoides induced intestinal obstruction is a sequel of this parasitic infestation. It presents as colic, vomiting (bilious or non-bilious), abdominal distention and at times peritonitis. Management includes indoor admission, intravenous fluids, rectal enemas and serial clinical and radiological assessment for detecting any indication of surgery. We in our study we analysed the outcome of conservative management and use of oral administration of 76% gastrograffin. Methods: Clinical parameters of all these patients were recorded and kept under close monitoring of the clinical parameters. Patients were initially subjected to conservative treatment whereby patients were advised nil per oral, naso-gastric tube aspiration, intravenous fluid, rectal enemas and antibiotics as indicated. In some patients without signs of peritonitis and severe obstruction contrast agent gastrograffin was administered either per oral or via naso-gastric tube. Serial abdominal radiographs were taken. Surgical intervention was performed if worms were not expelled after 48-72 hr of conservative treatment or contrast gets held up after 24 to 36 hrs in small intestines or clinical deterioration. Data was analysed stastically. Results: A total of 240 patients were included in this study. The abdominal pain 156 (65%) was the most common symptom followed by distension in 168 (70%). Among patients, 65% were boys (n=156) and 35% girls (n=84). The clinical signs included abdominal distention in 168 (70%), tenderness in 28 (11%), rigidity 34 (14%), palpable worm masses in 115 (48%) and visible gut loops in 29 (23%). Most of the patients 204 (85%) responded to conservative management. Among 36 patients who needed surgery, 10 patients had received oral contrast. The pre-operative findings included-impacted worms in 14 cases, impacted worm mass with gangrene 6 cases, intussusceptions without gangrene 7 cases and gut volvulus with gangrene in 9 cases. The average hospital stay was 4.40 ± 2.25 days in cases managed conservatively, whereas about 10.35 ± 6.24 days in cases needing surgical intervention. There was no mortality in our series. Conclusion: Ascaris induced worm obstruction should be managed conservatively, surgery is indicated if conservative management does not result in clinical improvement. Addition of gastrograffin orally in some patients without complete obstruction significantly decreases the hospital stay and reduces the time period between admission to expulsion of the worms.

Author(s):

Raashid Hamid*

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