Surgical decision-making in pediatric intestinal ascariasis: experience from an endemic region

BACKGROUND: Intestinal ascariasis is the leading cause of pediatric intestinal obstruction in endemic regions. This study aimed to analyze the clinical presentation, diagnostic accuracy, and outcomes of conservative and surgical management of ascariasis-induced intestinal obstruction in children. METHODS: Children aged 2-16 years who presented with intestinal obstruction between May 2022 and May 2025 were prospectively evaluated. Patients with intestinal ascariasis confirmed as the cause of obstruction were included, whereas those with concomitant adhesions, intussusception, or other etiologies of obstruction were excluded. Data on demographics, management strategies, operative details, complications, and hospital stay were analyzed. RESULTS: Of the 190 children with intestinal obstruction, 120 (63.2%; 95% CI: 56.3-70.0%) were diagnosed with ascariasis-induced obstruction. There was a male predominance (male-to-female ratio 2:1). The mean age at presentation was 5.8 ± 2.3 years, with the highest incidence observed in the 5-8-year age group (54.2%), followed by the 2-4-year age group (37.5%). Initial conservative management was attempted in 80 of the 120 patients, of whom 65 (81.3%; 95% CI: 72.7-89.8%) improved without surgical intervention. Surgical management was required in 55 patients (45.8%; 95% CI: 36.9-54.7%). The procedures performed included manual kneading of worms (36.4%), enterotomy with worm extraction (32.7%), and bowel resection with end-to-end anastomosis (30.9%). Postoperative complications were observed in eight patients (14.5%; 95% CI: 5.4-23.7%), including surgical site infection (7.3%), anastomotic leak (3.6%), and burst abdomen (3.6%). No mortality was observed. The mean length of hospital stay was 4.2 ± 1.5 days for patients managed conservatively and 7.8 ± 1.5 days for those who underwent surgical intervention. Ultrasonography demonstrated a diagnostic accuracy of 96.5% (95% CI: 93.1-99.8%) and PPV of 100% (95% CI: 95.6-100%) among patients who underwent imaging, with characteristic "bull's-eye" and "railway-track" appearances of intraluminal worms. CONCLUSION: Ascariasis remains the predominant cause of pediatric intestinal obstruction in endemic areas, underscoring its persistent public health relevance. Although conservative management is effective in most cases, timely surgical intervention remains essential for patients with complications or failed conservative treatment.