Abdominal complications of ascariasis in childhood

• Published in: Jornal de pediatria Vol. 100; no. 5; pp. 460 - 467
• Main Authors: Siviero, Ivonete, de Almeida, Ugo V.B., Penna, Claudia R.R., Di Puglia, Elazir B.M., Simões, Betina C. Bertrand
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01-09-2024; Sociedade Brasileira de Pediatria; Elsevier
• Subjects: Abdominal Pain - etiology; Abdominal Pain - parasitology; Ascariasis; Ascariasis - complications; Ascariasis - diagnosis; Ascariasis - therapy; Ascaris lumbricoides; Child; Humans; Intestinal obstruction; Intestinal Obstruction - etiology; Intestinal Obstruction - parasitology; PEDIATRICS; Surgical complications; Surgical complications; Ascariasis; Ascaris lumbricoides; Intestinal obstruction; Child
• ISSN: 0021-7557; 1678-4782; 1678-4782
• DOI: 10.1016/j.jped.2024.02.001

Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients.
A PubMed search was conducted using the key terms “ascariasis complications” and “hepatobiliary ascariasis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023.
Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed.
The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.