Irfan.
Ascariasis: An unusual Radiological Differential Diagnosis.
Pak Armed Forces Med J Jan ;51(1):63-6.

A 25 years old young lady, admitted in civil hospital, referred to our department for barium meal and follow-through study. She was having pain upper abdomen associated with vomiting for last 4 days. There was no history of passing blood in the vomitus. Past history revealed that she had a laparotomy about 5 years back, when she was in Afghanistan. Nature of surgery was not known.

On clinical examination an ill-defined mass was palpable in epigastrium/ slightly tender on deep palpation. Ultrasonography abdomen, was normal. Barium meal and follow-through study revealed multiple linear filling defects in stomach and proximal small gut. Some of these filling defects were having high density central core as well. There was no other abnormality in stomach or duodenum. Possibility of Ascariasis was considered as an option.

Patient was managed conservatively by deworming her twice with symptomatic and supportive therapy. But she did not pass worms in stools or in vomitus and there was no symptomatic relief. Keeping in view there condition and previous history of laparotomy, possibility of peritoneal adhesions and subacute intestinal obstruction was considered. At laparotomy, there were no adhesions or signs of peritonitis and gut was healthy. Linear coiled structures were palpable in stomach and proximal small gut, On exploration of gut, surgeons removed about two meters of electric wire from stomach, duodenum and jejunum. There was multiple pieces of wire having different lengths, some of which contain metallic core as well. This actually mimicked the barium the gut of the worm.

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