Abdominal complications of Ascaris lumbricoides in children

Abstract

Human infestation with Ascaris lumbricoides is common in tropical and subtropical areas and is responsible for 20% of acute admissions annually to the surgical wards of the Red Cross Children's Hospital. Of the 225 children with symptomatic ascariasis seen during the 5-year period 1985–1989, 66% were intestinal, 30% hepato-biliary, and 4% pancreatic. Real-time ultrasound was the method of choice for diagnosis of invasion of the biliary and pancreatic systems. Eighty-four per cent resolved within 3 days after a short transient illness. Endoscopic retrograde cholangio-pancreatography was performed 15 times in 13 children when conservative measures failed and hepato-biliary infestation persisted. Complete removal of common bile duct worms was achieved in 55%. Thirty-seven (16%) were operated upon for deteriorating intestinal obstruction or persistent biliary and complicated hepatic disease. Indications for surgery are suspicion of ischaemic bowel, persistence of common bile duct worms for more than 4–6 weeks, liver disease, and persisting pseudocyst of the pancreas.