|Year : 2016 | Volume
| Issue : 2 | Page : 130-132
Incidental finding of meckel's diverticulum in a patient with ascaris-induced intestinal obstruction
Mohit Bhatia, Vishal Tomar, Ravi Shankar
Department of Pediatric Surgery, Safdarjung and VMMC Hospital, New Delhi, India
|Date of Web Publication||30-Nov-2016|
1, Bank Colony, Opposite Old Sessions Courts, Ambala City - 134003, Haryana
Source of Support: None, Conflict of Interest: None
Ascaris lumbricoides is a large parasite that infests the human bowel, especially in regions with poor environmental sanitation in the tropics. Meckel's diverticulum is mainly an asymptomatic congenital intestinal anomaly. Rarely, it becomes symptomatic when it is associated with complications such as diverticulitis, perforation, and bleeding. It may be associated with a heavy worm load. We report a case of 7-year-old female child with intestinal obstruction and incidental finding of Meckel's diverticulum with gangrenous bowel.
Keywords: Ascariasis, intestinal obstruction, Meckel's diverticulum
|How to cite this article:|
Bhatia M, Tomar V, Shankar R. Incidental finding of meckel's diverticulum in a patient with ascaris-induced intestinal obstruction. Arch Int Surg 2016;6:130-2
|How to cite this URL:|
Bhatia M, Tomar V, Shankar R. Incidental finding of meckel's diverticulum in a patient with ascaris-induced intestinal obstruction. Arch Int Surg [serial online] 2016 [cited 2021 Jan 20];6:130-2. Available from: https://www.archintsurg.org/text.asp?2016/6/2/130/194990
| Introduction|| |
Intestinal obstruction and infestation by Ascaris is mostly seen in developing countries. In most of the cases, it remains asymptomatic, however, in cases with heavy worm load, it can result in complications such as obstruction, perforation involving appendix or Meckel's diverticulum, or biliary ascariasis.
Incidence and severity of complications depends on factors such as a high burden of worm and worm size. Radiological modalities often helps in detecting worm in bowel with sonographic images depicting intestinal worm bolus, floating worms with free fluid, and sluggish peristalsis. Preoperative diagnosis of Meckel's diverticulum associated with worm infestation is rarely made, and hence in most of the cases, it is an incidental finding.
Here, we present a case of 7-year-old female child with massive worm infestation along with an incidental finding of Meckel's diverticulum.
| Case Report|| |
A 7-year-old female child presented with a history of abdominal pain/distension with recurrent vomiting (with worms in the vomitus), and high grade fever since 4 days. On examination, the child had a toxic look. Abdominal findings revealed abdominal distension [Figure 1], with generalized tenderness and rebound tenderness in lower abdomen. Total leucocyte count was 18700, and her hemoglobin was 8 gm/dl. Plain X-ray of the abdomen revealed multiple air fluid levels. Ultrasound of the abdomen showed sluggish peristalsis with worms entangled with free fluid. Ryles tube was inserted to decompress the upper gastrointestinal tract. The patient was subjected to emergency exploratory laparotomy. Intraoperative findings comprised Meckel's diverticulum with gangrenous segment of terminal ileum because of volvulus with worm bolus in the terminal ileum and proximal segment [Figure 2]. Resection of the gangrenous bowel segment, diverticulectomy, and appendectomy with proximal ileostomy was done [Figure 3] and [Figure 4]. Thorough lavage was given and the patient had an uneventful postoperative period and was discharged on postoperative day 6.
|Figure 4: Specimen showing Meckel's diverticulum and appendix with resected bowel segment|
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| Discussion|| |
Although ascariasis remains mostly asymptomatic, it can lead to abdominal complications, varying from intestinal obstruction, perforation, volvulus, and rarely Meckel's diverticulitis. The most common complication caused by ascariasis is intestinal obstruction. However, in some cases, association of Meckel's with ascariasis has been found, which is probably due to worm incarceration resulting from the blockage of the base of diverticulum by interlocking of the roundworms. Because of worm bolus obstruction (due to compromise in vascularity caused by worm bolus), ileal perforation and gangrene occurs secondary to pressure necrosis. Volvulus of the ileal segment because of impacted worm bolus can further lead to gangrene of Meckel's diverticulum.
Meckel's diverticulum is a commonly seen anomaly of gastrointestinal tract. Due to a heavy load of worms, possibility of getting entangled at the narrow base of the diverticulum are high, therefore resulting in perforation of diverticulum. Perforation of Meckel's diverticulum is rarely caused by the roundworms. Perforation at the tip of the diverticulum is due to the pressure necrosis caused by the impacted worms.
Studies have justified the removal of silent Meckel's diverticulum in an emergency surgery for ascariasis intestinal obstruction, and have also mentioned the use of diverticulectomy site as an enterotomy site for the complete removal of worms.
| Conclusion|| |
A surgeon treating a case of ascaris-induced intestinal obstruction should always be vigilant for the possible complications associated with ascariasis. Meckel's diverticulum may remain asymptomatic but if found during the surgery should be removed prophylactically in view of its anticipated complications. Early surgical intervention in patients with features of peritonitis will help in reducing mortality and may salvage the bowel.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]