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65 J uly-December 2008 / Vol 5 / Issue 2 African J ournal of Paediatric Surgery

Intestinal obstruction in children due to Ascariasis:


A tertiary health centre experience
P. K. Mishra, A. Agrawal, M. Joshi, B. Sanghvi, H. Shah, S. V. Parelkar
Department of Paediatric Surgery, K.E.M. Hospital and Seth G.S.
Medical College, Mumbai, India
Correspondence:
Dr. Pankaj Kumar Mishra,
Department of Paediatrics Surgery,
Ward 3, K.E.M. Hospital,
Parel, Mumbai, India.
E-mail: drpankajmishra@gmail.com
Original Article
ABSTRACT
Background: Ascariasis is the infestation by the largest
intestinal nematode of man, a common problem in the
tropics attributed to poor hygienic and low socioeconomic
conditions. The aim of this research is to analyse the
presentation, diagnosis and management of bowel
obstruction caused by Ascaris lumbricoides, with special
emphasis on the role of conservative management.
Materials and Methods: This is a single centre, two
consultant based 5 year retrospective study of childhood
intestinal obstruction due to worms. Diagnosis in the
suspected patients was based on history of passage
of worms per mouth or rectum and on x-ray and
ultrasonography ndings. Only the patients of intestinal
obstruction with documented evidence of roundworm
infestation were included in the study and were followed
for one year. Results: One hundred and three children
with intestinal obstruction due to Ascaris lumbricoides
were treated in the past five years at our centre.
Abdominal pain was the most common presentation
seen in 96 children followed by vomiting in 77 children.
20 children had history of vomiting worms and another
43 had history of passing worms in stool. Abdominal
tenderness was present in 50 children, 48 had abdominal
distension of varying degree, 50 had abdominal mass
due to worm bolus, and 16 had or developed abdominal
guarding or rigidity. All the children were managed as for
acute intestinal obstruction along with hypertonic saline
enema. The aim of management was to starve the worm
and hydrate the patient. 87 patients (84.47%) responded
favourably and were relieved of the obstruction by the
conservative management, 16 children (15.53%) had
abdominal guarding or rigidity and underwent emergency
exploration. Conclusion: Roundworm obstruction should
be considered in the differential diagnoses of all cases
of intestinal obstruction in children. Clinical history and
examination along with X-ray and ultrasonography are
very helpful for diagnosis of this surgical emergency.
Most cases of intestinal obstruction due to Ascaris
can be managed conservatively; however emergency
INTRODUCTION
Ascari asi s i s a common probl em i n the tropi cs. Poor
hygi eni c and l ow soci oeconomi c condi ti ons have
been the mai n factors i ncri mi nated. Common surgi cal
probl ems
[1,2]
caused by Ascari s i nfestati on i ncl ude
smal l i ntesti nal obstructi on, vol vul us, i ntussuscepti on
and perforati on usual l y i nvol vi ng the i l eum. In our
envi ronment over 70% of chi l dren
[1-5]
are i nfested wi th
Ascari s l umbri coi des, the l argest i ntesti nal nematode
of man. I t i s esti mated that more than 1.5 bi l l i on
peopl e are i nfested gl obal l y wi th Ascari s l umbri coi des,
representi ng 25 percent of the worl d popul ati on.
[6,7]

Ascari asi s causes about 10,00,000 new cases annual l y
and 60,000 mortal i ti es i n a year the worl d over.
[8,9]

Al though Ascari asi s occurs at al l ages, i t i s most
common i n chi l dren 2 to 10 years ol d
[10]
and preval ence
decreases over the age of 15 years.
MATERIALS AND METHODS
Thi s i s a si ngl e centre, two consul tant based, 5 year
retrospecti ve study of chi l dhood i ntesti nal obstructi on
due to roundworms. Onl y the pati ents of i ntesti nal
obstructi on wi th documented evi dence of roundworm
i nfestati on admi tted and managed over the peri od
of fi ve years (January 2002- December 2007) i n the
department of paedi atri c surgery were i ncl uded i n
the study and were fol l owed for one year. Data were
anal ysed retrospecti vel y for age, gender, cl i ni cal
features, management and outcome of management.
Di agnosi s i n the suspected pati ents was based on
hi story of passage of worms per mouth or rectum and
on x-ray and ul trasonography fi ndi ngs. Al l pati ents
were exami ned by ul trasound scanni ng i n both supi ne
surgery is needed in patients with abdominal guarding
and rigidity.
Key words: Hypertonic saline enema, intestinal
obstruction, roundworms, ultrasonography
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African J ournal of Paediatric Surgery 66 J uly-December 2008 / Vol 5 / Issue 2
and i n l eft l ateral posi ti on to i ncrease the di agnosti c
effi cacy.
Management ai ms to starve the worms and hydrate
the pati ent . Al l the pati ents were managed as for
acute i ntesti nal obstructi on by keepi ng them ni l by
mouth, nasogastri c aspi rati on, i ntravenous fl ui ds and
hypertoni c sal i ne enema twi ce dai l y. The hypertoni c
sal i ne enema was used onl y for di sentangl i ng and
ex pul si on of col oni c worms and chi l dren were
watched cl osel y for any features of dehydrati on. No
anti hel menthi c drugs were gi ven to the pati ent duri ng
the acute stage. However pati ents who had abdomi nal
guardi ng or ri gi di ty or those who devel oped them i n due
course were taken for emergency expl orati on.
Eval uati on of other fami l y members was carri ed out
whenever the di agnosi s was made because of the
propensi ty of the i nfestati on to cl uster i n fami l i es.
On fol l ow-up, al l the pati ents were gi ven al bendazol e
therapy two weeks after di scharge from hospi tal and
were eval uated at three months and at the end of one
year to ensure that no ova were detectabl e i n stool ,
ei ther because of i nadequate el i mi nati on of adul t
worms or because of re-i nfestati on, and an extra dose of
al bendazol e therapy was gi ven to the posi ti ve cases.
RESULTS
One hundred and three pati ents wi th i ntesti nal
obstructi on due to Ascari s l umbri coi des were treated
i n the past fi ve years at our centre. There were thi rty-
ei ght (36.89%) gi rl s and si xty-fi ve (63.11%) boys.
Most of the chi l dren were i n the 4 to 8 years age
group, wi th peak occurrence at 5 to 6 years of age.
Abdomi nal pai n was the most common presentati on
i n 96 (93.20%) chi l dren, fol l owed by vomi ti ng i n 77
(74.76%). Twenty (19.43%) chi l dren had hi story of
vomi ti ng worms and another 43 (41.75%) had hi story
of passi ng worms i n stool . Twenty-two (20.36%) had
fever, 30 (29.13%) had hi story of consti pati on and
four (3.88%) had hi story of di arrhoea. Ni ne chi l dren
(8.74%) had hi story of taki ng anti hel menthi c drugs
wi thi n one week of presentati on to the hospi tal . Fi fty
(48.54%) chi l dren had abdomi nal tenderness, 14
(13.59%) of whom had abdomi nal guardi ng or ri gi di ty
at presentati on and 2 (1.94%) devel oped them duri ng
the course of conservati ve management. 48 (46.60%)
chi l dren had abdomi nal di stensi on of varyi ng degrees,
50 (48.54%) had abdomi nal mass due to bol us of worms,
and si x (5.83%) had features of dehydrati on. X-ray
suggested the di agnosi s i n 54 pati ents (52.43%) and
i n 91 pati ents (88.35%) the di agnosi s was confi rmed
on ul trasonography. Ei ghty-seven chi l dren (84.47%)
responded favourabl y to conservati ve management
and passed worms per rectal l y from thi rd to fi fth day
onwards and di d not requi re any surgi cal i nterventi on.
However duri ng conservati ve management three
chi l dren devel oped features of mi l d dehydrati on and
el ectrol yte i mbal ance and were managed successful l y.
Al l chi l dren who presented wi th abdomi nal guardi ng
or ri gi di ty and those who devel oped them subsequentl y
were taken for emergency expl orati on (14 and two
respecti vel y). Of the 16 chi l dren who had emergency
surgery, seven had bol us of worms, si x had vol vul us and
gangrene of smal l bowel , two had i l eal perforati on [Fi gure
1] and one had appendi cul ar perforati on. Out of si x
pati ents wi th vol vul us and gangrene, fi ve were managed
by resecti on and anastomosi s and l oop i l eostomy was
performed i n the si xth case. Of the two chi l dren wi th
i l eal perforati on one was managed by doubl e l ayered
repai r and resecti on and anastomosi s was performed for
another. Appendectomy was performed for pati ent wi th
appendi cul ar perforati on. One chi l d wi th l arge bol us of
worms and thi nned out i l eal wal l requi red enterotomy
for extracti on of the worms. The remai ni ng si x chi l dren
were managed by manual mi l ki ng of the worms from
the bowel [Fi gure 2].
Out of si xteen chi l dren who underwent surgery,
two had wound i nfecti ons, and one wi th i l eostomy
had peri stomal excori ati on but they al l responded
to conservati ve management. One of the chi l dren
wi th vol vul us and gangrene of smal l bowel managed
by resecti on and anastomosi s had l eak from the
anastomosi s si te; he underwent rel aparotomy and
i l eal stoma was made but subsequentl y he devel oped
septi caemi a and di ed.
Ni nety pati ents turned up for the 1
st
fol l ow up vi si t at
the end of three months of whi ch 48 were posi ti ve for
roundworm ova. Fi fty-one turned up for the 2nd vi si t
at the end of one year of whi ch 32 were posi ti ve for
roundworm ova. Al l posi ti ve cases were treated wi th
an extra dose of al bendazol e. One pati ent, who di d not
turn up for fol l ow up, presented at the end of 18 months
wi th i ntesti nal obstructi on due to roundworms and was
managed conservati vel y wi th good outcome.
DISCUSSION
Roundworm rel ated i ntesti nal obstructi on i s more
common i n chi l dren because of the smal l er di ameter of
the l umen of the bowel and, often, an i ncreased worm
Mishra PK et al.: Round worm obstruction in children
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67 J uly-December 2008 / Vol 5 / Issue 2 African J ournal of Paediatric Surgery
l oad. Transmi ssi on occurs mai nl y vi a i ngesti on of water
or food contami nated wi th Ascari s l umbri coi des eggs
and occasi onal l y vi a i nhal ati on of contami nated dust.
Chi l dren pl ayi ng i n contami nated soi l may acqui re the
parasi te from thei r hands and thi s can be the reason
for greater i nci dence of thi s condi ti on i n boys as they
are more exposed to outdoor acti vi ti es; si mi l ar hi gh
i nci dence i n mal e pati ents i s al so reported by other
authors.
[11]
Transpl acental mi grati on
[12]
of l arvae has
al so occasi onal l y been reported. Adul t worms do not
mul ti pl y i n the human host, so the number of adul t
worms per i nfested person rel ates to the degree of
conti nued exposure to i nfecti ous eggs over ti me. In
Indi a, the preval ence of hi gh-i ntensi ty Ascari s i nfecti on,
i n whi ch there i s a hi gh worm burden, i s 768 cases per
100,000 persons;
[13]
gl obal l y, there are an esti mated
62 mi l l i on persons
[13]
wi th hi gh-i ntensi ty Ascari s
l umbri coi des i nfestati on. Intesti nal obstructi on i s an
especi al l y acute probl em i n the devel opi ng worl d.
[13]

The preval ence of Ascari s-rel ated i ntesti nal obstructi on
i n I ndi a i s 9.2 cases per 100,000 persons.
[13]
There
are nearl y 730,000 cases of Ascari s-i nduced bowel
obstructi on and 11,000 deaths annual l y worl dwi de.
The majori ty of i nfestati ons wi th Ascari s l umbri coi des
are asymptomati c. However, the burden of symptomati c
di sease worl dwi de i s sti l l rel ati vel y hi gh because of
the hi gh preval ence of di sease. Cl i ni cal di sease
[9,14]

i s l argel y restri cted to i ndi vi dual s wi th a hi gh worm
l oad.
[15]
One revi ew esti mated the worm burden wi th
i ntesti nal obstructi on to be >60 (and ten ti mes hi gher
i n fatal cases).
[16]
When symptoms do occur, they rel ate
ei ther to the l arval mi grati on stage or to the adul t worm
i ntesti nal stage.
Heavy i nfestati ons wi th Ascari s are frequentl y bel i eved
to resul t i n abdomi nal di scomfort, anorexi a, nausea
and di arrhoea. However, i t has not been confi rmed
whether or not these non-speci fi c symptoms can trul y
be attri buted to Ascari asi s.
[17]
Mishra PK et al.: Round worm obstruction in children
Figure 1: Round worm causing ileal perforation
Figure 3: X-ray showing multiple air uid level with cigar bundle appearance
of round worms
Figure 2: Milking of small intestine to evacuate round worms
Figure 4: Ultrasound appearances of round worms
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African J ournal of Paediatric Surgery 68 J uly-December 2008 / Vol 5 / Issue 2
A mass of worms can obstruct the bowel l umen i n
heavy Ascari s i nfestati on, l eadi ng to acute i ntesti nal
obstructi on. The obstructi on occurs most commonl y at
the i l eocecal val ve. Symptoms i ncl ude col i cky abdomi nal
pai n, vomi ti ng and consti pati on. Vomi tus may contai n
worms. Approxi matel y 85 percent of obstructi ons
occur i n chi l dren between the ages of one and fi ve
years.
[15]
Someti mes an abdomi nal mass that changes
i n si ze and l ocati on on seri al exami nati ons
[18]
may
be appreci ated. Compl i cati ons i ncl udi ng vol vul us,
[19]

i l eocecal i ntussuscepti on, gangrene, and i ntesti nal
perforati on occasi onal l y resul t.
The di agnosi s was kept i n mi nd i n al l cases of i ntesti nal
obstructi on i n paedi atri c age group and was based on
hi story of passage of worms i n vomi tus or stool
[20,21]

al ong wi th X-ray and ul trasonographi c features of
roundworm and i ntesti nal obstructi on. I n heavi l y
i nfested chi l dren, l arge col l ecti ons of worms may be
vi sual i sed on pl ai n fi l m of the abdomen as radi ol ucent
areas
[22]
or wi th a ci gar bundl e appearance [Fi gure 3].
Occasi onal l y the mass of worms created contrasts
agai nst the gas i n the bowel , typi cal l y produci ng a
whi rl pool effect.
[23]
Radi ographs al so showed features
of associ ated i ntesti nal obstructi on l i ke abdomi nal
di stensi on, di l ated bowel l oops and mul ti pl e ai r fl ui d
l evel s and free gas under di aphragm i n cases wi th
i ntesti nal perforati on.
Ul trasonography [Fi gure 4] of the abdomen has been
advocated as a qui ck, safe, non-i nvasi ve and rel ati vel y
i nexpensi ve modal i ty for suspected i ntesti nal Ascari asi s
and vari ous appearances of roundworms have been
descri bed l i ke a thi ck echogeni c stri p wi th a central
anechoi c tube or mul ti pl e l ong, l i near, paral l el
echogeni c stri ps wi thout acousti c shadowi ng.
[24-28]
Other characteri sti c fi ndi ngs were vi sual i sati on of
si ngl e worm, bundl es of worms, or a pseudo tumour-
l i ke (hel menthi noma)
[29]
appearances. Some ti mes
i ndi vi dual body segments of worms were vi si bl e as
mul ti pl e pai rs of curvi l i near echogeni c l i nes, and
on prol onged scanni ng, the worms showed curl i ng
movements. The al i mentary canal of the worm was seen
ei ther as a si ngl e central echogeni c l i ne i n col l apsed
state or as two paral l el hypoechoi c bands wi th a
hypoechoi c centre i n di stended state al so descri bed
as a wi ndi ng hi ghway or paral l el l i nes .
[24-26]
When
exami ned transaxi al l y, the i ndi vi dual worm resembl ed
a target wi th i ts ci rcul ar, echogeni c body wal l and i ts
central dot-l i ke al i mentary canal .
The ai m of our management to starve the worms and
hydrate the pati ent i s based on the fact that roundworms
are dependent on the parti al l y di gested nutri ents i n the
smal l i ntesti ne for survi val . So by keepi ng the pati ents
ni l by mouth we are i ndi rectl y starvi ng the worms whi ch
promotes thei r movement and di sentangl ement. The
hydrati on part of the management emphasi ses the need
for proper fl ui d therapy so as to avoi d any untoward
compl i cati on duri ng the conservati ve therapy.
The hypertoni c sal i ne enema
[30]
causes i rri tati on and
promotes di sentangl i ng and expul si on of col oni c
worms, however duri ng i ts use chi l dren shoul d be
watched cl osel y for any features of dehydrati on.
We di d not use any anti hel menthi c agent duri ng the
course of conservati ve management as they al ter the
moti l i ty of the worms and hamper thei r cl earance and
may l ead to seri ous compl i cati ons l i ke i ntussuscepti ons,
vol vul us, haemorrhagi c or necroti c bowel and even
perforati on.
[21,31]
Re-i nfestati on occurs frequentl y; more than 80 percent
of i ndi vi dual s i n some endemi c areas become re-
i nfested wi thi n si x months.
[15]
The overal l i nci dence of
obstructi on i s approxi matel y 1 i n 500 chi l dren.
[15]
In
endemi c areas, i t has been shown that between 5 and
35 percent of al l cases of bowel obstructi on are due to
ascari asi s.
[15]
Mul ti pl e worms frequentl y remai n i n the
i ntesti nes for several years wi thout causi ng di sease.
There are 4 major factors that resul t i n Ascari s-rel ated
i ntesti nal obstructi on.:
[23]
1. Mul ti pl e worms can form a l arge bol us, resul ti ng i n
mechani cal obstructi on of the bowel l umen. Thi s i s
the most frequent cause of Ascari s- rel ated bowel
obstructi on.
2. The worm bol us may serve as a l ead poi nt i n
i ntussuscepti on or a pi vot i n smal l bowel vol vul us.
3. Ascari s worms may i nhabi t the i l eocecal val ve,
where roundworm secreti on of neurotoxi ns prompts
smal l -bowel contracti on. Thi s acti on, coupl ed
wi th hi gh worm burden i n the i l eocecal val ve, can
obstruct the i ntesti ne.
4. A host i nfl ammatory reacti on to worm-deri ved
haemol ysi ns, endocri nol ysi ns, and anaphyl atoxi ns
can be severe enough to obstruct the gut l umen.
Bowel perforati on i s thought to fol l ow i schemi a from
pressure by the mass of worms i n the i l eum. Thi s vi ew
was however questi oned by Efem
[5]
who postul ated that
except i n confi ned spaces l i ke the appendi x, Meckel s
di verti cul um and the bi l i ary tree, the i ntesti ne i s
capabl e of i mmense di l atati on to accommodate up to
5000 worms wi thout symptoms. Typhoi d perforati ons,
Mishra PK et al.: Round worm obstruction in children
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69 J uly-December 2008 / Vol 5 / Issue 2 African J ournal of Paediatric Surgery
non-speci fi c ul cers and anastomoti c suture l i nes are
thought to provi de exi ts for the worm.
Vari ous other authors
[32,33]
have performed si mi l ar
studi es i nvol vi ng paedi atri c pati ents and exami ned
the use of conservati ve versus surgi cal management of
i ntesti nal obstructi on due to Ascari asi s and reported a
hi gh success rate wi th conservati ve therapy. Unl i ke the
other mechani cal causes of i ntesti nal obstructi on most
cases of acute i ntesti nal obstructi on due to Ascari asi s
can be managed conservati vel y.
At the ti me of di scharge and i n fol l ow up chi l dren
and thei r parents were advi sed regardi ng use of toi l et
faci l i ti es, safe excreta di sposal , protecti on of food from
di rt and soi l , thorough washi ng of raw food materi al s,
hand washi ng, and common-sense sani tary measures.
Mass treatments wi th si ngl e dose mebendazol e or
al bendazol e for al l school -age chi l dren every three to
four months have been used i n some communi ti es. Thi s
serves the dual functi on of treati ng the chi l dren and
reduci ng the overal l worm burden i n the communi ty.
Indeed, mass communi ty therapy has been shown to
reduce Ascari s burden and transmi ssi on. Al though i t has
a greater effect on the i ntensi ty of i nfestati on than on the
overal l preval ence,
[34-37]
thi s approach has been shown
to be cost-effecti ve.
[38]
Because re-i nfestati on occurs so
frequentl y, shorter i nterval s between treatments have
been found to be preferabl e. Targeted treatment hel ps
control the morbi di ty of i nfestati on but does not have
a substanti al effect on transmi ssi on.
[29,39,40]
I n concl usi on, roundworm obstructi on shoul d be
the di fferenti al di agnosi s of al l cases of i ntesti nal
obstructi on i n chi l dren. Proper hi story wi th l eadi ng
questi ons regardi ng passage of worms i n vomi tus and
stool and hi story of i ntake of any anti hel menthi c drug
i n recent past al ong wi th careful cl i ni cal exami nati on
l ooki ng speci fi cal l y for abdomi nal guardi ng and ri gi di ty
are essenti al for the proper di agnosi s and management
of thi s condi ti on. X-ray and ul trasonography are
very hel pful for di agnosi s of thi s surgi cal emergency.
Uncompl i cated cases of i ntesti nal obstructi on due
to Ascari s can be managed conservati vel y; however
surgery i s needed i n pati ents wi th compl i cati ons.
REFERENCES
1. Otu AA. Tropical surgical abdominal emergencies: Acute intestinal
obstruction. Afr J Med Med Sci 1991;20:83-8.
2. Archibong AE, Ndoma-Egba R, Asindi AA. Intestinal obstruction in
south-eastern Nigerian children. East Afr Med J 1994;71:286-9.
3. Wani NA, Shah OJ, Wani MA. Surgical complications of abdominal
ascariasis. Postgrad Doctor Afr 2002;24:38-40.
4. Hassan AW. Intestinal obstruction due to ascariasis. Niger J Surg Sci
1993;3:91-3.
5. Efem EE. Ascaris lumbricoides and intestinal perforation. Br J Surg
1987;74:683-4.
6. Embil J, Pereira L, White F, Garner J, Manuel F. Prevalence of ascaris
lumbricoides infection in a small Nova Scotian community. Am J
Trop Med Hyg 1984;33:595-8.
7. Crompton D. How much human helminthiasis is there in the world?
J Parasitol 1999;85:397-403.
8. Drake L, Bundy D. Multiple helmet infections in children: Impact
and control. Parasitological 2001;122:73-81.
9. Cooper PJ, Chico ME, Sandoval C, Espinel I, Guevara A, Kennedy
MW, et al. Human infection with Ascaris lumbricoides is associated
with a polarized cytokine response. J Infect Dis 2000;182:1207-
13.
10. Haswell-Elkins M, Elkins D, Anderson RM. The influence of
individual, social group and household factors on the distribution
of Ascaris lumbricoides within a community and implications for
control strategies. Parasitology 1989;98:125-34.
11. Gangopadhyay AN, Upadhyaya VD, Gupta DK, Sharma SP, Kumar
V. Conservative treatment for round worm intestinal obstruction.
Indian J Pediatr 2007;74:1085-7.
12. Chu WG, Chen PM, Huang CC, Hsu CT. Neonatal ascariasis. J
Pediatr 1972;81:783-5.
13. Murray CL, Lopez AD. Global health statistics: A compendium of
incidence, prevalence and mortality estimates for over 200 conditions.
Vol II. Boston: Harvard University Press; 1996. p. 394-405.
14. Somoro MA, Kantar J. Non-operative management of intestinal
obstruction due to ascaris lumbricoides. J Cull Physicians Surge Pak
2003;13:86-9.
15. Khuroo MS. Ascariasis. Gastroenterol Clin North Am 1996;25:553-
77.
16. De Silva NR, Guyatt HL, Bundy DA. Worm burden in intestinal
obstruction caused by Ascaris lumbricoides. Trop Med Int Health
1997;2:189-90.
17. Availabel from: http://www.stanford.edu/class/humbio103/
ParaSites2005/Ascaris/JLora_ParaSite.htm#Intestinal#Intestinal.
18. Tietze PE, Tietze PH. The roundworm, Ascaris lumbricoides. Prim
Care 1991;18:25-41.
19. Montiel-Jarqun A, Carrillo-Ros C, Flores-Flores J. Ascaridiasis
vesicular asociada a hepatitis aguda: Manejo conservador. Cir Ciruj
2003;71:314-8.
20. Dvila GC, Trujillo HB, Vsquez C. Prevalenca de parasitosis
intestinales en nios de zonas urbanas del estado de Colima, Mxico.
Vol. Med Hosp. Infanta Mes 2001;58:234-9.
21. Vasquez Tsuji O, Gutierrez Castrellon P, Yamazaki Nakashimada
MA, Arredondo Suarez JC, Campos Riveral T, Martinez Barbosa I.
Anthelmintics as a risk factor in intestinal obstruction by Ascaris
lumbricoides in children. Bol Chil Parasitol 2000;55:3-7.
22. Mahmood T, Mansoor N, Quraishy S, Ilyas M, Hussain S.
Ultrasonographic appearance of Ascaris lumbricoides in the small
bowel. J Ultrasound Med 2001;20:269-74.
23. Vilamizar E, Mendez M, Bonilla E, Varon H, de Onatra S. Ascaris
lumbricoides infestation as a cause of intestinal obstruction in
children: Experience with 87 cases. J Pediatr Surg 1996;31:201-5.
24. Hoffmann H, Kawooya M, Esterre P, Ravaolimalala-Thomas AK,
Roux-Seitz HM, Doehring VE. In vivo and in vitro studies of the
sonographic detection of Ascaris lumbricoides. Pediatr Radiol
1997;27:226-9.
25. Peck RJ. Ultrasonography of intestinal Ascaris. J Clin Ultrasound
1990;18:741-3.
26. Brazilai M, Khamaysi N. Sonographical imaging of Ascaris
lumbricoides. Harefuah 1996;131:247-8.
27. Khuroo MS, Zargar SA, Mahajan R, Bhat RL, Javid G. Sonographic
appearances in biliary ascariasis. Gastroenterology 1987;93:267-
72.
Mishra PK et al.: Round worm obstruction in children
[Downloadedfreefromhttp://www.afrjpaedsurg.orgonWednesday,September25,2013,IP:103.10.67.52]||ClickheretodownloadfreeAndroidapplicationforthis
journal
African J ournal of Paediatric Surgery 70 J uly-December 2008 / Vol 5 / Issue 2
28. Anand R, Narula M, Gupta A. Images: Biliary ascariasis. Indian J
Radiol Imaging 1999;9:23.
29. Malde HM, Chadha D. Roundworm obstruction: sonographic
diagnosis. Abdom Imaging 1993;18:274-6.
30. Mukhopadhyay B, Saha S, Maiti S, Mitra D, Banerjee TJ, Jha M, et
al. Clinical appraisal of Ascaris lumbricoides, with special reference
to surgical complications. Pediatr Surg Int 2001;17:403-5.
31. Rodriguez-Garcia AJ, Belmares-Taboada J, Hernandez-Sierra JF.
Ascaris lumbricoides-caused risk factors for intestinal occlusion and
subocclusion. Cir Cir 2004;72:37-40.
32. Ochoa B. Surgical complications of ascariasis. World J Surg
1991;15:222-7.
33. Upadhyaya VD, Gangopadhyaya AN, Pandey A, Gupta DK,
Upadhyaya A. Round worm intestinal obstruction: A single center
study. Int J Surg 2007;12:7.
34. Hall A, Anwar KS, Tomkins AM. Intensity of reinfection with Ascaris
lumbricoides and its implications for parasite control. Lancet
1992;339:1253-7.
35. Asaolu SO, Holland CV, Crompton DW. Community control of
Ascaris lumbricoides in rural Oyo State, Nigeria: Mass, targeted and
selective treatment with levamisole. Parasitology 1991;103:291-8. Source of Support: Nil, Conict of Interest: None declared.
36. Thein-Hlaing, Than-Saw, Myat-Lay-Kyin. The impact of three-monthly
age targetted chemotherapy on Ascaris lumbricoides infection. Trans
R Soc Trop Med Hyg 1991;85:519-22.
37. Thein-Hlaing, Than-Saw, Myat-Lay-Kyin. Control of ascariasis through
age targeted chemotherapy: Impact of 6-monthly chemotherapeutic
regimens. Bull World Health Organ 1990;68:747-53.
38. Holland CV, OShea E, Asaolu SO, Turley O, Crompton DW. A cost-
effectiveness analysis of anthelminthic intervention for community
control of soil-transmitted helminth Infection: Levamisole and Ascaris
lumbricoides. J Parasitol 1996;82:527-30.
39. Anderson RM, Medley GF. Community control of helminth
infections of man by mass and selective chemotherapy. Parasitology
1985;90:629-60.
40. Holland CV, Asaolu SO, Crompton DW, Whitehead RR, Coombs
I. Targeted antihelmenthic treatment of school children: Effect of
frequency of application on the intensity of Ascaris lumbricoides
infection in children from rural Nigerian villages. Parasitology
1996;113:87-95.
Mishra PK et al.: Round worm obstruction in children
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