A 35-year-old woman presented with generalized abdominal pain for the past 2 years. The pain was intermittent and moderate in intensity. There was no anorexia, vomiting, or fever. Her bladder and bowel habits as well as physical and abdominal examination were normal.
The routine blood and urine tests were also unremarkable. The ultrasound done as a first-line imaging investigation showed normal solid organs with normal caliber of gut loops. However, contrast-enhanced computed tomography (CECT) was done to ascertain any pathology missed on sonography. CECT showed small gut intussusception with worms as lead point (Figure 1). The patient was reviewed on ultrasound the next day by a consultant radiologist. The patient was prepared by making her drink 1.5 L water in 1 hour to distend the small gut by water as air hinders sonographic evaluation. Sonography showed no feature of intussusception that was seen on CECT, but the worms could be delineated (Figure 2). So it was a rare and interesting case of transient entero-enteric intussusception with worms as lead point. The patient's stool examination was positive for ova of Ascaris lumbricoides. There was no acute symptom so she was managed conservatively with oral albendazole.
A. lumbricoides is a common cause of bowel obstruction in children in tropics and subtropics (Supplemental Video). But A. lumbricoides as a cause of intussusception in adults is very unusual and described as a handful of case reports.1 The abdominal complications can be broadly categorized into intestinal and extraintestinal. The gastrointestinal complications include mechanical bowel obstruction, volvulus, intussusception, appendicitis, peritonitis, or even perforation.2 The extraintestinal abdominal complications are biliary colic, cholelithiasis, cholecystitis, liver abscess, and pancreatitis.
Karatepe O, Tükenmez M, Hünerli K, Cıtlak G, Salmaslıoglu A, Battal M, Erbil Y, 2008. Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception. Am J Emerg Med 26: 381.e3–e4.
Ramareddy RS, Alladi A, Siddapa OS, Deepti V, Akthar T, Mamata B, 2012. Surgical complications of Ascaris lumbricoides in children. J Indian Assoc Pediatr Surg 17: 116–119.