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Surgical Complications of Ascariasis in Children (Abstract)

C. Esposito¹, A. Settimi¹, M. De Marco¹, C. De Fazio¹, Giurin I¹, A. Savanelli¹, Alicchio F¹ and G. Esposito¹,²

¹Chair of Pediatric Surgery “Federico II” University, Naples, Italy

²Department of Emergency “Ospedale Cardarelli”, Naples, Italy



Background: Ascariasis is usually a benign disease caused by the parasite Ascaris Lumbricoides, prevalent in tropical zones. Sometimes it leads to severe surgical complications requiring urgent treatment and having a high morbidity and mortality, especially in non endemic areas where the parasitosis is infrequent and in which the diagnosis may be retarded. Surgical complications may involve mainly the intestine and septicemia may be a severe postoperative complication, whose pathogenesis may be the release of endotoxins by dead worms.

Material and Methods: In a 5-years period, five children aged from 4 to 8 years (median 5.6) presented with acute abdominal symptoms lasting from 1 to 4 days and characterized by generalized abdominal pain, vomiting and closed alvus. The preoperative diagnosis was acute appendicitis for three patients, intestinal volvulus for one and intestinal intussusception for the last one.

Results: At laparotomy there were two purulent peritonitis, an intestinal volvulus and two invaginations, one ileo-ileal and the other ileo-cecal. Surgery consisted in an intestinal resection in the two patients with intestinal gangrene, in detorsion of the volvulus, and in desinvagination. Patients not requiring intestinal resection underwent enterotomy to remove the parasites. In all cases the lesion was due to the presence of a mass of about 200-300 worms located in the loops above the lesions responsible of peritonitis or above the intestinal obstructions. The postoperative course was uneventful in three cases and complicated by toxemic septic shock in two. Treatment was successful in three patients, whereas the two patients with the septic shock died after surgery.

Conclusions: Our study proves that the intestinal complications of ascariasis may be a fatal event that may occur in the countries where the parasitosis is infrequent because of the resulting retard of its diagnosis, as occurred in three of our five cases and the consequent delayed treatment.

Key words: Ascariasis, Ascaris lumbricoides, intestinal complications


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