The ascariasis (AL) is most common in tropical and subtropical areas. Estimations reveal near 1 000 000 of new annual cases and 60 000 fatalities in a year. Many studies advocate for conservative treatment for partial intestinal obstruction due to round worm but we are presenting a study emphasizing initial conservative treatment for complete intestinal obstruction due to round worm without sign and symptoms of perforation and peritonitis.

» Material and Methods

All the patients with suspected round worm intestinal obstruction with out signs and symptoms of peritonitis admitted in pediatric surgery department of Institute of Medical Sciences B.H.U., Varanasi India from 2003-2005 were included in study. Patients presented with sign and symptom of peritonitis or perforation were excluded form our study. A total of 22 patients were admitted during this period. All patients were initially subjected to conservative treatment (nil by mouth, intravenous fluid, nasogastric tube aspiration, rectal enemas (glycerine liquid paraffin enema) and piperazine salt through nasogastric tube for 3 consecutive days) after getting the informed consent from patients. They were closely monitored with assessment of vital parameters and abdominal girth measurement and serial abdominal X - ray. Serial follow-up X-rays were taken at 8, 24, and 48 h. Clinical improvement was defined as a decrease in abdominal pain and distension, decrease in abdominal girth and associated passage of flatus or stool. The Radiological improvement was defined as a decrease in number of dilated bowel loops or decrease in the diameter of dilated small bowel. The treatment protocol followed at our center, is conservative with appropriate intravenous fluid, nasogastric suction, antispasmodic, antibiotics and anthelmintic therapy (Piperazine salt @ 75mg/Kg) followed by rectal enemas (glycerine liquid paraffin enema) for three consecutive days. Patients are considered for surgical intervention if (three patients in our series).

(a) Worms are not expelled after 24 - 48 hr of conservative treatment as per our protocol.

(b) There is any deterioration on clinical parameters

» Result

All the cases were from low socioeconomic groups. Most common age of presentation was 4-8 year (67%) . History of anithelminthic treatment in recent pass was present in 59% (13/22) cases. X-ray was suggestive for round worm obstruction in 54% (12/22) cases where as ultrasonographic finding were positive in 77% (17/22) cases. Out of 22 patients only 3 (13.6%) patient required surgical treatments and rest responded well to conservative line of management. Mean hospital stay for conservative treatment was 4.1 days (range 4 - 5 days). Those patients who required surgical intervention stayed in hospital for about 2 weeks. There was no mortality in present series. In all patients who required surgical intervention the bolus of the worm was pushed to the large bowl by milking the intestine and latter on worms were expelled out of the rectum by its own. One patient required re-exploration that not improved after operation; he had ischemic changes in bowel and required bowel resection and end to end anastomosis.