~ildlan.~ Pldtat. 43: 2fit;. 197~:

VOLVULUS OF THE

SMALL BOWEL DUE TO

ASCARIS*

R. N a r t a u o AND RAj KUMAr

Wardha Awaris lumbricoides has b e e n m a n ' s i, e0mmonest intestinal parasite since the Stone Age. I t is k n o w n to cause a variety bf a b d o m i n a l surgical emergencies, e.g. intestinal obstruction, i n f l a m m a t i o n a n d ~t~sttnJction o f the biliary tract, pancreatitis, appendicitis a n d p r i m a r y peritonitis. O u t bfthese, the c o m m o n e z t is acute small bowel bbstruction, d u e to obliteration of it.~ l u m e n . relatively rare m e c h a n i s m of obstruction ts volvulus in association w i t h obliteration. ,(cry few cases o f the latter variety have been r e p o r t e d (Cole 1965, W a l l e r a n d ~ t h e r s o n 1970) w h i c h has p r o m p t e d the i'ollowing report. Report of a Case

M . G . , a 3-year-old m a l e child was ~ d m i t t e d on 6.9.75 w i t h history o f a b d o m i nat p a i n off a n d on for two m o n t h s . T w o .days p r i o r to a d m i s s i o n he d e v e l o p e d i b d o m i n a l distension, v o m i t i n g a n d absolute ~onstipation. T h e r e was a histo,--y o f passage o f one r o u n d w o r m 15 days a n d ~'aother three w o r m s four days before this ~cute episode. O n e x a m i n a t i o n the child ~ a s very iLl, toxic a n d grossly d e h y d r a t e d ~rith a pulse rate of 160/rain. a n d t e m p e r a ~ure o f I40~ T h e a b d o m e n was grossly Idistended a n d a n irregular t e n d e r mass was Llelt in the right, iliac fossa a n d h y p o g a s t r i u m . LBowel sounds were absent. R e c t a l e x a m i [From the Department of Surgery, Mahatma Gandhi ~ i t u t e of Medical Science~, Sevagram, "vVardha 2zo2.

lt~:eived on May 5, 1976.

n a t i o n r e v e a l e d a b u l g e in t h e recto-vesical pouch. I n view o f the history o f chronic r e c u r r e n t a b d o m i n a l p a i n a n d passage of r o u n d w o r m s d u r i n g t h e two weeks prior to a d m i s s i o n , a diagnosis o f intestinal obstruction d u e to r o u n d w o r m was suspected. W h i t e cell c o u n t was 9,400 w i t h 45% p o l y m o r p h s , 30% l y m p h o c y t e s a n d 25% eosinophils. S t r a i g h t X - r a y o f the abdom e n showed m u l t i p l e fluid levels in distend e d loops of small intestine a n d a soft tissue mass in the lower a b d o m e n w i t h linear t r a n s l u c e n t shadows inside it p a t h o g n o m o n i c of r o u n d w o r m infestation. After i m p r o v e m e n t in his general c o n d i t i o n w i t h i n t r a v e n o u s fluids a n d other supportive measures, a l a p a r o t o m y was d o n e t h r o u g h a transverse l o w e r a b d o m i n a l muscle c u t t i n g incision. O n o p e n i n g the p e r i t o n e u m s o m e free fluid w i t h faecal m a t t e r was sucked out. A bulky g a n g r e n ous l o o p o f t e r m i n a l i l e u m w h i c h h a d u n d e r g o n e volvulus was lying in the pelvis. It h a d a few perforations t h r o u g h wbSch faecal m a t t e r a n d a c o u p l e o f r o u n d w o r m s h a d c o m e out a n d w e r e lying in the pelvis. T h e affected loop was full o f r o u n d w o r m s , m a n y o f wb.ich c o u l d also be felt in the small a n d large intestines. R e s e c t i o n of the g a n g r e n o u s s e g m e n t of i l e u m with end to e n d anastomosis was done. T h e w o u n d was closed after p e r i t o n e a l toilet. 60 worms were recovered from the excised bowel a n d a n o t h e r 20 were passed in the stools in r_he days following the operation. H e d e v e l o p e d w o u n d dehiscence w h i c h was sutured. T h e subsequent recovery was quite satisfactoi3-.