CASE I: Intestinal Obstruction from MID Gut Volvulus Intestinal Parasitism

A 2-years-old child was brought to the hospital with complaints of worsening abdominal pain over
the previous 3 days. She had not passed urine or flatus for 3 days, accompanied by complaints of
vomiting. She had an abdominal pain for 2 weeks and had history of diarrhea. Physical exam reveals
bloated abdomen that appeared to have dark contour which was painful when pressed with a
palpable mass at the right lower quadrant and with an auscultation of minimal peristalsis. Other
head-to-toe assessments were within normal limits, appears to be thin, and with symptoms and
signs of malnutrition. An abdominal x-ray examination showed intestinal obstruction at the right
lower area. This case was presented as an emergency and was advised for exploratory laparotomy.

Client’s Profile:

Name: X

Age: 2 years old

Gender: Female

Case Number: 394613

Date of Admission: December 18, 2023

Chief Complaint:

Abdominal pain, vomiting, and diarrhea

Past Health History:

No prior illness, the symptoms worsened after a week. Complete immunization. No known allergies
to food and drugs. No major surgeries and hospitalization injuries.

Gordons (assumed):

The patient loves to play outside and bath along river side. She eats well but had a decreased
appetite last year.

(No further since it was an emergency case….)

LABORATORY and Diag (Possible):

1. CBC: All, except for WBC make it abnormal: WBC Count 13 (Normal Range: 5-10x10^9/L)

CBC Differential: Results must reveal abnormal in eosinophilia

2. Fecalysis (Kato Katz): Brown

Ova Parasites: Positive for Ascaris Lumbricoides Ova

3. Urinalysis:

Color: Yellow

Clarity: Clear

pH:7.5

Special Gravity: 1.0004

Leukocyte: Negative

Pus Cells: 13.50

Red Cells: 2.40

4. Culture and Sensitivity (Blood): No growth after 5 days of incubation

5. Ultrasonography: Results – Thick echogenic strips along right lower quadrant, with minimal acites,
and normal sonographic evaluation of liver, kidneys, urinary bladder, spleen, and pancreas.

RISK FACTORS:

Children <10 years old (likes to play with dirt)

Warm climate (Tropical)

Poor sanitation (Human feces mixed in soil)

Low Immune Status

Low Provision of water

Complications:

Acute Abdomens

Upper GI bleeding

Intussusception and volvulus

Peritonitis

*Toxins released by ascaris produce intestinal ischemia and infarction resulting in necrotic patches in
the intestinal wall.

Gangrenous bowel wall

Compx:

Intestinal blockage

Nutritional deficiency

Colon Cancer

Medical Management:

-Albendazole

-Mebendazole

-Ivermectin

Surgical Management:

-Emergency Exploratory Laparatomy

-Resection of Gangrenous Bowel Segment Peritoneal Washing

-Creation of Ileostomy

-Jackson-Pratt Drain

-Biopsy of Lymph Nodes

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