Management of roundworm obstruction in the light of pathogenesis
Sarkar, P.K.; Pan, G.D.; Bhowmick, P.K.
Journal of the Indian Medical Association 85(1): 5-8
1987
ISSN/ISBN: 0019-5847 PMID: 3611810 Document Number: 297505
Forty-three children with abdominal obstruction due to Ascaris lumbricoides were studied in Calcutta, India. 18 presented with severe colicky abdominal pain, hyperperistalsis, constipation, fullness of abdomen, with or without vomiting and 16 presented with moderate pain and sluggish peristalsis. They were treated conventionally with antispasmodic im injections 8 hourly for 3 days or longer, fluids to combat dehydration, gastric suction in cases of repeated vomiting and moderate abdominal distension, anthelmintics - oral piperazine when normal peristalsis was re-established on days 4-6 and metronidazole iv to combat anaerobic colonization. Blood transfusion was given only in cases where surgical intervention was anticipated. In 29 cases obstruction was relieved by the expulsion of large numbers of worms/rectum on days 3 to 5 from the start of treatment. The condition of the remaining 5 patients deteriorated and they were operated on; 3 survived the operation. 9 children presenting with dull ache, silent abdomen, gross distension, toxic symptoms, raised temperature, vomiting and weak rapid pulse were initially selected for surgery but 2 proved unfit for anaesthesia. Ascarids associated with gangrenous gut were the principal cause of obstruction in 4 of the 12 operated children; in the remainder, associated mechanical factors (bands, strictures) were responsible for the obstruction and the worm bolus played a secondary role.