Ascaris lumbricoides roundworms visible on a plain -non-contrast- abdominal x-ray in a patient presenting with gastric outlet obstruction
Lykourgos Christos Alexakis
The Pan African Medical Journal. 2017;26:184. doi:10.11604/pamj.2017.26.184.12232

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Ascaris lumbricoides roundworms visible on a plain -non-contrast- abdominal x-ray in a patient presenting with gastric outlet obstruction

Cite this: The Pan African Medical Journal. 2017;26:184. doi:10.11604/pamj.2017.26.184.12232

Received: 11/03/2017 - Accepted: 13/03/2017 - Published: 29/03/2017

Key words: Ascariasis, gastric outlet obstruction, radiology

© Lykourgos Christos Alexakis et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/26/184/full

Corresponding author: Lykourgos Christos Alexakis, Médecins Sans Frontières, 1st Department of Internal Medicine, “G, Gennimatas” General Hospital, Athens, Greece (lchalexakis@gmail.com)


Ascaris lumbricoides roundworms visible on a plain -non-contrast- abdominal x-ray in a patient presenting with gastric outlet obstruction

Lykourgos Christos Alexakis1,2,&

 

1Médecins Sans Frontières, Athens, Greece, 21st Department of Internal Medicine “G. Gennimatas” General Hospital, Athens, Greece

 

 

&Corresponding author
Lykourgos Christos Alexakis, Médecins Sans Frontières, 1st Department of Internal Medicine "G. Gennimatas” General Hospital, Athens, Greece

 

 

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A 29 years old male from Bangladesh presented in the emergency department with severe abdominal pain and symptoms of gastric outlet obstruction. Epigastric tenderness, tachycardia, low grade fever, leucocytosis (WBC: 14900/μL) with neutrophilia (Neu:10900/μL) and eosinophilia (Eos:600/μL) were noted, as well as features of obstructive jaundice (increased AST, ALT, and total bilirubin). Stomach dilation was noted on a chest X-ray (A), while in a plain abdominal erect X-ray (C) tubular curvilinear soft tissue densities in a jejunal loop were identified (D). An abdominal CT scan showed stomach dilation and gave the impression of thickening of the pyloric wall and superior part of duodenum (B). In addition, a distended gallbladder, a common bile duct of one cm in diameter and borderline distention of intrahepatic ducts were observed. Subsequently, a nasogastric tube was placed which drained 2 litres of food containing liquid. Antibiotics, opioid analgesics and intravenous fluids were also given. During gastroduodenoscopy a bundle of several entangled Ascaris Lumbricoides roundworms was identified obstructing the duodenum lumen and some of them were removed endoscopically. Following albendazole treatment for three days and passing several dead worms per rectum, the patient recovered and radiological findings resolved completely.

 

 

Figure 1: A) chest X-ray showing stomach dilation, prominent gastric air bubble and gastric air-fluid level; B) abdominal CT showing stomach dilation; C) erect abdominal plain X-ray with visible worms in the left upper quadrant (red square); D) detail of panel C (red square) showing tubular or cord-like curvilinear soft tissue densities in a jejunal loop characteristic of ascaris worms (red arrows)

 

 

 

 

 

 

 

 


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Volume 27 (May - August 2017)

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