Obstructive Ileal Ascariasis
A 10-year-old Kenyan girl presented with abdominal pain that had grown progressively worse over a period of 3 days. Nonprojectile, nonbloody vomiting and abdominal distention had also developed. On examination, she was cachectic, with a distended abdomen and a soft, tender mass at the right iliac fossa that was associated with guarding and tenderness on percussion. She did not have a cough or chest pain. Laboratory assessment was notable for anemia (hemoglobin level, 8 g per deciliter). Her clinical symptoms were suggestive of intestinal obstruction. She was brought to the operating room for an emergency laparotomy. During surgery, a mass of Ascaris lumbricoides in the terminal ileum was found to be causing obstruction (Panels A and B). A. lumbricoides may cause intestinal obstruction in children in the tropics. Depending on the presentation, the management can be conservative or surgical. Conservative management, after peritonitis and bowel strangulation have been ruled out, includes observation with rehydration, antimicrobial therapy, and analgesic agents. In the operating room, this patient underwent resection of the terminal ileum, followed by primary anastomosis. At a follow-up visit, she was asymptomatic, with recovery of appetite and weight.