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CASE REPORT
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 37-38

Ascariasis presenting as hematemesis in a young boy


Department of Medicine, Hamdard Institute of Medical Sciences and Research, Hamdard University, New Delhi, India

Date of Web Publication4-Jun-2015

Correspondence Address:
Mohammed Mushtaque Ahmad
G15, Department of Medicine, Hamdard Institute of Medical Sciences and Research, Hamdard University, New Delhi - 110 062
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-2010.158128

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  Abstract 

Most cases of round worm infestation are asymptomatic. Their migration to various unusual sites in the gastrointestinal tract leads to uncommon complications such as acute pancreatitis, biliary cholangitis, acalculus cholecystitis, and so on. Accumulation of worms inside intestinal lumen can lead to obstruction, intussuception, or volvulus. However, migration of the worm in the stomach and consequent hematemesis is a very rare complication. Acidic milieu of stomach and its strong peristalsis are considered to be the reason for this rarity. Mechanism of hematemesis is assumed to be erosion of the mucosa either by mechanical process or by the secretions of the worm. This young boy being presented here had vague abdominal complaints and later developed hematemesis along with vomiting out of three living round worms. He brought the worm to hospital and contributed in making prompt diagnosis. He was treated conservatively.

Keywords: Abdominal pain, Ascaris lumbricoides, complications, gastric ascariasis, hematemesis


How to cite this article:
Ahmad MM, Malik PK, Hassan S, Dwivedi S. Ascariasis presenting as hematemesis in a young boy. J Health Res Rev 2015;2:37-8

How to cite this URL:
Ahmad MM, Malik PK, Hassan S, Dwivedi S. Ascariasis presenting as hematemesis in a young boy. J Health Res Rev [serial online] 2015 [cited 2019 Dec 8];2:37-8. Available from: http://www.jhrr.org/text.asp?2015/2/1/37/158128


  Introduction Top


Ascaris lumbricoides , commonly known as round worms, are the largest nematodes that infest human beings. It is the most common helminthic infestation, with an estimated world prevalence of 25% (0.8-1.22 billion people). [1] Men acquire them by ingesting embryonated eggs present in unhygienic foods and drinks and hatch in duodenum. The small larvae penetrate duodenal mucosa, reach lungs through portal circulation, and molt twice there. They ascend tracheobronchial tree, swallowed, and lodge in small intestine to become adult worms. [2] Migration of the worms in the stomach in rare instances can lead to various uncommon complications. Occurrence of simultaneous hematemesis and vomiting out of live worms, as well as the very role of a patient in providing clue to correct diagnosis prompted us to communicate this report.


  Case report Top


A 17-year-old boy, who had been recently treated as acid peptic disease for his vague abdominal complaints, presented to medicine outpatient department complaining upper abdominal pain, belching, and small amount of hematemesis in early morning, at around 3:00 am. He was surprised by noticing three moving worms contained in the vomitus, which he collected in a jar and brought to the hospital [Figure 1]. His vitals were stable and systemic examinations were unremarkable. The specimens were identified as A. lumbricoides by the microbiologist. His stool examination also revealed fertilized eggs of A. lumbricoides. The patient was prescribed antihelminthic drug (albendazole) and proton pump inhibitor (pantoprazole).
Figure 1: Picture of the three live Ascaris lumbricoides vomited by the patient and brought to hospital

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  Discussion Top


Round worms (A. lumbricoides, named from their resemblance to earth worm) are transmitted via fecal-oral route, mainly from ingestion of water or food (especially vegetables and fruits) contaminated with their eggs. [3] Adult worms reside in jejunum and proximal ileum. Most cases of infestations are asymptomatic. Accumulation of large and tangled worms can lead to partial or complete intestinal obstruction, and consequent intussuception, volvulus, or gangrene. [4] Being a highly motile parasite, it can enter biliary and pancreatic ducts, leading to biliary colic, cholangitis, acalculus cholecystitis, and acute pancreatitis. [5],[6] However, migration to stomach is rare, probably due to highly acidic environment and strong peristalses in stomach. [7]

Anisakis simplex and Pseudoterranova decipiens are the nematodes that are known to cause hematemesis. [2] Hematemesis from gastric ascariasis is very rare, only reported in some isolated case reports. [8],[9] Most of them found the worms attached to blood oozing erosions in the stomach, indicating mechanical process of bleeding. However, mucosal irritation by worm's secretions has also been proposed as the mechanism of bleeding. [10] Other reported complications of gastric ascariasis include gastric outlet obstruction, volvulus, perforations, [11] and dyspeptic symptoms. Our case amply illustrates the significance of patient's contribution in diagnosis, which was otherwise missed initially. Furthermore, it is worthwhile to remember Ascariasis as one of the cause of hematemesis, especially in tropical countries.

 
  References Top

1.
Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: Ascariasis, trichuriasis, and hookworm. Lancet 2006;367:1521-32.  Back to cited text no. 1
    
2.
Elliot DE. Intestinal infections by parasitic worms. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran′s Gastrointestinal and Liver Diseases. 9 th ed. Saunders;Philadelphia: 2010. p. 1921-39.  Back to cited text no. 2
    
3.
Puri R, Choudhary NS, Sud R. A young female with recurrent biliary pain. J Dig Endosc 2013;4:138.  Back to cited text no. 3
  Medknow Journal  
4.
Yetim I, Ozkan OV, Semerci E, Abanoz R. Rare cause of intestinal obstruction, Ascaris lumbricoides infestation: Two case reports. Cases J 2009;2:7970.  Back to cited text no. 4
    
5.
Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet 1990;335:1503-6.  Back to cited text no. 5
    
6.
Wasadikar PP, Kulkarni AB. Intestinal obstruction due to ascariasis. Br J Surg 1997;84:410-2.  Back to cited text no. 6
    
7.
Choudhuri G, Saha SS, Tandon RK. Gastric ascariasis. Am J Gastroenterol 1986;81:788-90.  Back to cited text no. 7
[PUBMED]    
8.
Bhasin DK, Chhina RS. Hematemesis in gastric ascariasis. Am J Gastroenterol 1989;84:1585-6.  Back to cited text no. 8
[PUBMED]    
9.
Pontes JM, Leitao MC, Portela F, Andrade P, et al. Gastric ascariasis: A rare cause of upper gastrointestinal bleeding. Endoscopy 1996;28:792-3.  Back to cited text no. 9
    
10.
Gupta R, Saraswat VA. Endoscopic diagnosis and removal of Ascaris lumbricoides from the stomach. Endoscopy 1993;25:378.  Back to cited text no. 10
    
11.
Gupta S, Kumar S, Satapathy A, Ray U, Chatterjee S, Choudhury TK. Ascaris lumbricoides: An unusual aetiology of gastric perforation. J Surg Case Rep 2012;2012: pii: rjs008.  Back to cited text no. 11
    


    Figures

  [Figure 1]


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