Diagnosis and analysis of ascariasis intestinal obstruction in infants

Mentioning ascariasis intestinal obstruction should be familiar to people before the 1980s, especially infants and young children. At that time, due to the relatively backward medical and health care in all aspects, the incidence of this disease was still quite high, mainly concentrated in children. Of course, with the improvement of living standards and the popularization of various immunization measures, the incidence of ascariasis intestinal obstruction has been very low, but it still exists, so let's discuss its diagnosis below.

Diagnosis and differential diagnosis

① Diagnosis: The diagnosis of ascariasis intestinal obstruction is generally not difficult. Children with paroxysmal abdominal pain and vomiting can feel a deformed mass of Ascaris lumbricoides in their abdomen, and the diagnosis can usually be confirmed by combining it with an upright abdominal X-ray. Depending on the duration and severity of intestinal obstruction and whether it is accompanied by intestinal volvulus, children may have different degrees of clinical manifestations. In the early stages of incomplete intestinal obstruction, there may be only mild dehydration and acidosis. In cases of complete intestinal obstruction and intestinal blood flow disorders, symptoms such as abdominal pain and vomiting will also worsen, and abdominal distension, abdominal tenderness and muscle tension will gradually appear. When a mass of Ascaris lumps causes intestinal torsion, the child's condition becomes extremely critical due to rapid intestinal necrosis and toxin absorption.

② Differential diagnosis

Intussusception is more common in infants. The clinical manifestations are paroxysmal crying, vomiting, bloody stools and abdominal masses, most of which are located in the right upper abdomen. Ascariasis intestinal obstruction mostly occurs in children over 3 or 4 years old. There is usually no blood in the stool. The lumps are mostly around the navel, with an uneven surface, a cord-like feeling or deformation when pressed, and no tenderness in the early stages. If necessary, barium or gas enema examination can be used for differentiation.

When intestinal tuberculosis or abdominal tuberculosis causes intestinal obstruction, it sometimes resembles ascariasis intestinal obstruction. Lumps may also be felt in the abdomen, but there may be multiple lumps of varying sizes and shapes with a hard texture, which can be distinguished from characteristic ascaris masses. Children with intestinal tuberculosis and abdominal tuberculosis often have a history of abdominal pain, diarrhea, or other tuberculosis histories, and their general condition is poor.

Intestinal torsion caused by Ascaris lumbricoides should be diagnosed based on medical history or early manifestations of Ascaris ileus. However, sometimes it can only be diagnosed as acute strangulated intestinal obstruction, or misdiagnosed as hemorrhagic necrotizing enterocolitis, acute mesenteric vascular embolism, etc. Because people with the latter two diseases may also have symptoms such as abdominal cramps, lumps, and blood in the stool. Sometimes the diagnosis of intestinal volvulus caused by Ascaris lumbricoides can only be confirmed during laparotomy.

The most direct and effective way to diagnose ascariasis intestinal obstruction is to use X-rays to find out whether there are lumps in the upper abdomen, because these lumps are likely to be ascariasis clumps. At the same time, children at this time are prone to crying, accompanied by certain abdominal pain and vomiting. As for how the disease is contracted, most of it is still related to the hygiene of the environment and eating habits, which are important information for diagnosis.