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Ascariasis Causing Small Bowel Volvulus¹

¹ From the Departments of Radiology and Pathology, St Joseph’s Hospital and Medical Center, Phoenix, Ariz. Received October 17, 2002; revision requested November 18 and received December 16; accepted December 16. Address correspondence to E.J.R., Mary Lanning Memorial Hospital, 715 N St Joseph Ave, Hastings, NE 68901. (e-mail: ericrodriguez99@hotmail.com).

View larger version (168K): [in a new window]   Figure 1.  Radiograph demonstrates multiple loops of dilated bowel throughout the abdomen. Multiple air-filled tubular structures are also seen, mostly in the right lower quadrant (arrows).

View larger version (112K): [in a new window]   Figure 2a.  Sagittal (a) and transverse (b) US images of the left lower quadrant show multiple pairs of curvilinear echogenic lines within an adynamic, fluid-filled small bowel.

View larger version (95K): [in a new window]   Figure 2b.  Sagittal (a) and transverse (b) US images of the left lower quadrant show multiple pairs of curvilinear echogenic lines within an adynamic, fluid-filled small bowel.

View larger version (112K): [in a new window]   Figure 3a.  Contrast material-enhanced CT scans (a obtained at a higher level than b) of the abdomen demonstrate multiple dilated, fluid- and gas-filled loops of small bowel. Multiple curvilinear structures, most of which are gas filled, are seen within the bowel. These structures proved to represent the roundworm Ascaris lumbricoides.

View larger version (112K): [in a new window]   Figure 3b.  Contrast material-enhanced CT scans (a obtained at a higher level than b) of the abdomen demonstrate multiple dilated, fluid- and gas-filled loops of small bowel. Multiple curvilinear structures, most of which are gas filled, are seen within the bowel. These structures proved to represent the roundworm Ascaris lumbricoides.

View larger version (138K): [in a new window]   Figure 4a.  (a) Photograph obtained during exploratory laparotomy shows multiple loops of small bowel, all of which are necrotic. (b) Multiple A lumbricoides roundworms are seen through the bowel wall on this intraoperative photograph. (c) Photograph shows the excised small bowel full of roundworms.

View larger version (110K): [in a new window]   Figure 4b.  (a) Photograph obtained during exploratory laparotomy shows multiple loops of small bowel, all of which are necrotic. (b) Multiple A lumbricoides roundworms are seen through the bowel wall on this intraoperative photograph. (c) Photograph shows the excised small bowel full of roundworms.

View larger version (118K): [in a new window]   Figure 4c.  (a) Photograph obtained during exploratory laparotomy shows multiple loops of small bowel, all of which are necrotic. (b) Multiple A lumbricoides roundworms are seen through the bowel wall on this intraoperative photograph. (c) Photograph shows the excised small bowel full of roundworms.