SHM Converge Scientific Abstract ePoster Gallery-Bilious Worm Emesis Secondary to a Pediatric Intestinal Helminthic Infection

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This case report describes a 5-year-old boy who presented to the emergency department with abdominal pain and vomiting and was initially suspected to have viral gastroenteritis. Initial labs showed hyponatremia, elevated alkaline phosphatase, mild hyperproteinemia, leukocytosis with neutrophilia, and ketonuria. Imaging suggested stool burden and colonic distension, so he was admitted after receiving IV fluids.<br /><br />During hospitalization, he developed bilious emesis. An upper GI/small bowel follow-through showed mildly delayed contrast passage through the duodenum. He then vomited a live 24 cm worm, revealing that his symptoms were caused by a heavy intestinal helminth burden rather than a viral illness. He was managed conservatively with nasogastric suction, IV fluids, electrolyte correction, and mineral oil via the NG tube to help relax the worm before treatment. After a dose of mebendazole, he improved clinically and passed additional worms in stool before discharge.<br /><br />Further history obtained by the infectious disease team revealed that the child lived on a farm with multiple animal exposures, which should have raised earlier suspicion for parasitic infection. Laboratory identification confirmed the worm as Ascaris lumbricoides. The authors note that the elevated alkaline phosphatase and hyperproteinemia likely reflected acute helminthic infection.<br /><br />The report emphasizes the importance of considering ascariasis in children with gastrointestinal symptoms, especially when there is relevant exposure history. Ascaris lumbricoides is the largest human intestinal nematode and is more common in settings with poor sanitation. Adult worms can cause bowel obstruction or migrate into other organs. Although eosinophilia is often associated with helminth infection, it may be absent when adult worms are confined to the intestinal lumen.

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Andrea Lauffer

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Author List Andrea Lauffer, Francesca Giovannone, Hannah Leport, Jacob T. Kilgore, Jaineet Chhabra, Katherine D. Redmond, Mariana Lanata Piazzon, Rebekah Fabela, Samantha Smith, Susan L. Flesher

Category Clinical Vignettes

Concept Bilious Emesis

Concept Ascaris lumbricoides

Concept Bowel Obstruction

Concept Helminthic Infection

Concept Gastric Decompression

Distinguished Non-Finalist

Presenter Organization Marshall University School of Medicine

Presenting Author Andrea Lauffer

Track Pediatric

Keywords

ascariasis

Ascaris lumbricoides

pediatric abdominal pain

intestinal helminth infection

bilious vomiting

bowel obstruction

mebendazole

worm expulsion

farm animal exposure

elevated alkaline phosphatase

Bilious Emesis

Ascaris lumbricoides

Bowel Obstruction

Helminthic Infection

Gastric Decompression