Small bowel intussusceptions secondary to Ascaris lumbricoides in a child: a case report

Intussusception is one of the most common causes of bowel obstruction in children. Most cases are idiopathic without a pathological lead point, and only about 5 % have an identifiable cause, with Meckel's diverticulum being the most frequent. Ascaris worms are an exceptionally rare lead point in pediatric intussusception. A 10-year-old girl presented with a one-day history of crampy abdominal pain and frequent episodes of bilious vomiting. On examination, she was in pain, tachycardic (140 bpm), had dry mucous membranes, but was normotensive and afebrile. Abdominal examination was unremarkable except for diffuse pain. Laboratory evaluations were all within normal limits. Abdominal ultrasound showed a 10-cm-long small bowel to small bowel intussusception, 4 cm in diameter, with multiple non-mobile intraluminal objects, suspicious for ascaris lumbricoides. Following fluid resuscitation, the patient was taken to the operating room for an emergency exploratory laparotomy. We eviscerated the bowel and found that the intussusception had already spontaneously reduced. The involved bowel, which was a segment of the jejunum, was erythematous and edematous. The bowel was distended and filled with what seemed to be worms. We did a longitudinal enterotomy and found a conglomerate of ascaris lumbricoides, which we believe served as the pathologic lead point for the intussusception. All the worms were removed and the enterotomy was closed transversely in two layers. The patient had an uneventful postoperative recovery and was discharged home on the 5th postoperative day, on albendazole therapy. Although rare, Ascaris lumbricoides should be considered in the differential diagnosis of children who develop small bowel-to-small bowel intussusception.