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The

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images in clinical medicine

Obstructive Ileal Ascariasis


B

10-year-old Kenyan girl presented with abdominal pain that Aruyaru Stanley Mwenda, M.D.
had grown progressively worse over a period of 3 days. Nonprojectile, non- John Hamad Ilkul, M.D., M.M.Ed.
bloody vomiting and abdominal distention had also developed. On exami- Consolata Hospital
nation, she was cachectic, with a distended abdomen and a soft, tender mass at the Nyeri, Kenya
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.
DOI: 10.1056/NEJMicm1205279
Copyright 2013 Massachusetts Medical Society.

n engl j med 368;10 nejm.org march 7, 2013

The New England Journal of Medicine


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