Photo Rounds

Abdominal pain

A 52-year-old African woman sought care at a refugee clinic for severe abdominal pain and vomiting for 2 days. The family physician (FP) noted that her abdomen was distended, bowel sounds were intermittent and high pitched, and the abdomen was diffusely tender to palpation. The FP suspected a small bowel obstruction and the patient was sent to the nearest emergency center, where a segment of her small intestine was resected.

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Many Ascaris lumbricoides roundworms were seen in the resected bowel of this patient with bowel obstruction. A lumbricoides is a common parasite in Africa and Central America, especially where the drinking water is not clean. Although less common in the United States, it is found in tropical and subtropical areas, including the southeastern rural United States.

When fertilized eggs of A lumbricoides are ingested, they enter the circulation through the intestinal mucosa, travel to the lungs, climb to the pharynx, are swallowed, and finally find a “home” in the small intestine. If detected before there are complications, A lumbricoides can be treated with a single oral dose of either albendazole 400 mg or mebendazole 500 mg. In endemic areas outside of the United States, there are some public health programs that administer albendazole or mebendazole to at-risk children and adults every 3 to 6 months.

The patient described here recovered from her surgery. She and her family were all treated prophylactically with mebendazole to eradicate any remaining roundworms.

Photo courtesy of James L. Fishback, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H. Intestinal worms and parasites. In: Usatine R, Smith M, Mayeaux EJ, et al. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:916-920.

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