An intestinal volvulus perforated by <em>Ascaris lumbricoides</em> in a pediatric patient

Abstract

Ascariasis is an endemic condition in poor countries with a tropical and subtropical climate, with a high prevalence in children. The gastrointestinal form is the most typical presentation. When there is massive infestation, complications can occur that cause intestinal obstruction and perforation, requiring emergency surgical intervention. We present the case of a 13-year-old male patient of rural origin, treated at the National Hospital of San Miguel de Uspantan del Quiche, Guatemala, due to abdominal cramp and fever. He reported the occurrence of two vomiting episodes the day before. Physical examination revealed malnutrition by default, pale skin, increased hydro-aerial sounds in the abdomen, with marked distension, pain, involuntary muscle contracture, and the presence of tympanism. Body temperature was regulated. The patient was transfused with red blood cells and treated with intravenous solutions. Anesthetic induction and endotracheal intubation were performed. A nasogastric tube was placed and intravenous metronidazole was administered as the only available antimicrobial prophylaxis. An exploratory laparotomy was performed through a median, supra and infraumbilical incision. A perforated small bowel volvulus was observed, with marked necrosis. Devolvulation, digital stimulation and packing of the devitalized intestinal loops were performed with warm compresses of saline solution, without recovering the blood supply. Intestinal resection and colostomy were performed due to generalized peritonitis. In the postoperative period, the expulsion of Ascaris lumbricoides through the colostomy stoma was visualized. Treatment with albendazole was established. The patient was discharged after ten days and with a favorable progress.