a rare cause of SBO
i was reading up on small bowel obstruction (SBO) again as i went through all the upper and lower GI surgical diseases (glad i’m finally done with them). then i was flipping through Bailey and Love’s Short Practice of Surgery when i caught sight of this picture that gave me the creeps.
pparently, one of the rare causes of SBO are worms… (disturbing picture ahead…)
Ascaris lumbricoides is the largest of the common nematode (roundworm) infections of man. The white or yellow adult is 15-35 cm long and lives 10-24 months in the jejunum and middle ileum of the intestine. Each female produces 240,000 eggs per day, which are fertilized by nearby male worms. A recent study from China showed that 45% of infected persons shed only fertilized eggs, 40% shed fertilized and unfertilized eggs, and 20% shed only unfertilized eggs. Unfertilized eggs accounted for only 6-9% of eggs shed. Fertilized eggs released into favorable soil may become infectious within 5-10 days. Eggs may remain viable in soil for up to 17 months. Infection occurs through soil contamination of hands or food, ingestion, and the subsequent hatching of eggs in the small intestine. (Source: Emedicine)
Ultrasound of abdomen reveals a nasty find to be expected for the operation later.
Ok, that is the prize jewel (pictures credit). As can be seen, there is some ischaemia of the small intestine. I hope i don’t encounter many of these cases when i become a doctor/surgeon. Seriously, this is sick. Any one of you encountered these before? Bongi? Somewhat similar to your fettucini post i reckon.
OMG!
I’m lost for (other) words.
Ascaris lumbricoides is the 2nd most common cause of helminth infection in the U.S. Worth remembering for the USMLE Step 1.
Oh My God! I hope don’t have this kind of thing in my abdomen :S
It can cause intestinal perforation as well. A friend did an elective in India and saw about three perfs a week.
omg! thankfully i didn’t look at it just after my meal. i think i’ll remember this forever now.
Hi…i was wondering..if this can cause masive rectorrage?…sorry my english it sux..but..we had this case…38 yo guy…with chronical rectorrage..like rose wine..and we all suspected helminth..that caused perforation…anyone knows something about this?
im from spain..by the way..
omeegawd O.O” eww…i hope my small intestine ain’t like that! =/
Trust me, this is not the worst of it. Ascaris lumbricoides could migrate out of the intestines into other areas of the body. I am currently a med student, and I chose to enroll in a parasitology course. Its cool and all, the only complain I have is each time we do a dissection, it STINKS. The dissection I did with a fetal pig that was infected with ascaris, not only was it in the intestine, I also found some in places like the lungs and other pathways leading to the brain.
In response to Julia, unless the worm traveled to the anal capillaries or perforated some wall near the rectum or anus, I don’t think that there is much chances of that. Assuming that your suspicions are correct, you could try looking into other helminths like Trichuris trichuria that have been known to have caused prolapsed rectum or look into the possibility that it can be a mixed (more than 1 parasite) infection. Infection by helminths, patients usually exhibit higher than normal levels of eosinophils. There are also specific tests for each helminths, e.g. E.L.I.S.A.,etc…
Note: perforation of other abdominal areas can cause like symptoms.
However, I have to agree, Ascaris lumbricoides is amongst the most ‘disgusting’ imagery.
This is not rare in North America anymore
We have a global society
If you travel ask your doctor to send stool cultures (3 separate bowel movements)
If you are a physician, send stool cultures
It can be picked up on US but make sure your radiologist is trained outside of NA or Europe. Luckily many foreign trained radiologists (Indian are good) can pick this up on ultrasound.
Oh my. I have to do a project on this and ima bout to vomit. poor things. i feel bad for people that have that.
woowww…ese caso de ascariasis nunca lo habia visto
ni en la clinica da la facultad…yo estudio medicina veterinaria
y m gustaria ver mas casos de nematodiosis..por favor si tienes
mas fotos..publicalas..gracias..esutvo impresionante!!!