Small bowel volvulus secondary to ascariasis in a 4-year-old boy: A case report

Introduction: Small bowel volvulus occurs when a section of the small bowel rotates abnormally around its mesentery. Small bowel volvulus due to Ascaris infestation is a rare surgical occurrence. Case presentation: A 4-year-old boy from rural Ethiopia was brought to our pediatric emergency department with a four-day history of worsening abdominal pain, distension, and multiple episodes of bilious vomiting. He had a history of passing worms per rectum. On physical exam he was tachycardic, febrile, and had a distended, tender abdomen with guarding and rigidity. A plain abdominal X-ray showed multiple air-fluid levels and dilated bowel loops, suggestive of a small bowel obstruction. He was taken emergently to the operating room for an exploratory laparotomy. We found a volvulized partially necrotic segment of small intestine, 40 cm proximal to the ileocecal valve. The volvulized bowel was filled with worms. We devolvulized the bowel manually, did an enterotomy to remove the worms, resected 10 cm of necrotic bowel, and did an end-to-end anastomosis. On the 4th postoperative day, he exhibited signs of an anastomotic leak and was taken back to the operating room. We found no leak but could palpate more intraluminal Ascaris worms. We did a resection of a short segment of the ileum, removed all palpable Ascaris and did a re-anastomosis. He had an uneventful recovery following the second operation. Once he resumed bowel function, he received mebendazole 100 mg twice daily for 3 days. A second round of treatment was given 6 weeks later. Conclusion: Patients with intestinal Ascaris infestation carry a risk of developing small bowel volvulus and should therefore be closely monitored for that while they receive medical treatment. In the event of a volvulus, early intervention is critical to optimize outcomes.