Ascaris lumbricoides intestinal obstruction

　　The occurrence of Ascaris lumbricoides intestinal obstruction is related to the massive reproduction of Ascaris. Normally, the Ascaris寄生 in the intestines do not cause obstruction. However, when Ascaris reproduce in large numbers or when certain physiological changes occur in the human body, such as fever, diarrhea, intestinal dysfunction, allergic constitution, and enhanced intestinal peristalsis or insufficient dosage of anthelmintic drugs due to various stimulations, it can induce Ascaris movement, aggregation, and twisting into a ball, causing intestinal cavity obstruction. The number of Ascaris causing mechanical intestinal obstruction ranges from dozens to thousands, in addition, the metabolic products of Ascaris can stimulate the intestinal wall, causing spasm and obstruction.

　　If the obstruction caused by Ascaris lumbricoides is prolonged, a few patients may develop intestinal wall ischemia, necrosis, perforation, and other complications, leading to a large number of Ascaris entering the peritoneal cavity and causing various complications.

　　Early ascaris intestinal obstruction is mostly partial. It is manifested by intermittent abdominal pain, distension, nausea, vomiting, and sometimes vomiting or defecating ascaris. Abdominal pain is often colicky. During physical examination, the abdominal muscles are not significantly tense, and most patients can feel a string-like or sausage-like mass around the umbilicus or in the lower right abdomen, which has an uneven or窜动感, the mass can be slightly movable, and complete obstruction may occur in the late stage. The site of obstruction is often located at the end of the ileum.

　　The prevention of ascaris intestinal obstruction should adopt comprehensive measures, and the specific preventive measures are described as follows.

　　1. Control the source of infection and carry out general health examination and treatment.

　　2. In areas with an infection rate exceeding 70%, group treatment can be carried out to reduce the egg density of the soil and reduce the opportunity for transmission.

　　3. Strengthen faecal management, change personal hygiene habits, wash hands before meals and after defecation, do not eat uncooked vegetables or unclean sweet potatoes, carrots, etc.

　　4. Schools and kindergartens can regularly take anthelmintic drugs to prevent infection. Families can also give children anthelmintic drugs every quarter to prevent infection.

　　The examination of ascaris intestinal obstruction includes blood tests, faecal examination, X-ray and B-ultrasound examination, and the specific methods of examination are described as follows.

　　First, peripheral blood count and faecal examination

　　Eosinophils increase in peripheral blood. Faecal examination can detect eggs in faeces; if only males are parasitic, eggs cannot be found in the faeces.

　　Second, X-ray Examination

　　1. Obstructions often occur in the lower part of the small intestine, and incomplete obstruction is more common.

　　2. In some cases, a wavy or coarse-grained uneven shadow can be seen above the liquid level on the erect abdominal film, which is a typical 'camel hump' sign.

　　3. Various postures of ascaris can be seen in the abdominal films of most patients, or arranged in string-like formations, or curled into a ball to see the cross-sectional shadow of the ascaris with similar sizes and granular appearance, the shape keeps changing. The ascaris is about 5-6mm in diameter, and if the ascaris swallows air, linear or dot-like air shadows can be seen inside the ascaris. If the ascaris swallows barium, after the patient's intestines are cleared of barium, many linear or dot-like barium shadows can be seen.

　　4. Ascaris balls in the intestinal tract can also cause spasm, and disordered peristalsis can lead to intestinal torsion, even developing into strangulation and necrosis.

　　5. Ascaris that is lodged in the ileocecal valve due to spasm of the ileocecal valve is difficult to pass through, causing severe spasm pain. Under X-ray, a bundle of ascaris can be seen to be lodged in the ileocecal valve.

　　6. If there is necrosis and perforation of the intestine, the image of curled ascaris can be seen in the peritoneal cavity or abscess cavity around it.

　　Three, Ultrasound Examination

　　1. The intestinal tract above the obstruction is dilated, the lumen widened, with fluid and gas accumulation in the lumen, and multiple dilated intestines completely filled with fluid form a polycystic appearance. The fluid flows in the intestinal tract, and there is active reflux. In severe obstructions, there may be fluid leakage in the intestinal interstices.

　　2. The image of ascaris can be seen in the intestinal tract, with a strip-like strong echo for a single ascaris, which can be seen moving in the lumen. Multiple ascaris often aggregate into a ball. Ultrasound can be used to diagnose intestinal obstruction, and it can be identified by different acoustic shadows, and the effect is more ideal if it can complement X-ray examination.

　　Patients with ascaris intestinal obstruction should pay attention to their diet during the remission period, avoid eating hard foods, and focus on soft and thin foods. After the remission of ascaris intestinal obstruction, deworming treatment should be performed, including drug deworming, as well as oxygen therapy to expel intestinal ascaris. Avoid strenuous exercise after eating to prevent intussusception. Patients should eat protein-rich foods; eat iron-rich foods; eat foods that promote defecation. Avoid greasy, fishy, and spicy foods; avoid gas-forming foods; avoid foods with long dietary fibers.

　　Most cases of ascaris intestinal obstruction can be cured by non-surgical treatment. If the condition does not improve or worsens after non-surgical treatment, surgical treatment should be considered. The specific treatment methods are described as follows.

　　First, non-surgical treatment

　　1. Abstain from food, continuous gastrointestinal decompression, antispasmodic analgesic, correction of electrolyte and acid-base imbalance.

　　2. Oral acidic substances Patients with mild illness and good general condition can take compound acetylsalicylic acid (APC), vitamin C, or oral edible vinegar.

　　3. Drug deworming Currently, the use of compound mebendazole (mebendazole), albendazole (Intestinal Clear), and other drugs has satisfactory effects. However, some people advocate that deworming agents should be used with caution before the obstruction is relieved, otherwise, it may worsen the obstruction or increase the risk of complications.

　　4. Traditional Chinese Medicine Taking traditional Chinese medicine that promotes the passage of bowels and purges, such as ginger honey soup, prune soup, etc., or using acupuncture and massage to disperse the ascaris ball can also be adopted.

　　5. Oral oils Oral consumption of vegetable oils such as soybean oil, peanut oil, and Sichuan pepper sesame oil.

　　6. Enema Using warm saline or Dachengqi decoction for enema or rectal administration can also achieve certain efficacy. The use of air or oxygen enema can change the living environment of ascaris, paralyze it, and expel it from the body, but it is contraindicated in patients with intestinal ulcers, intestinal perforation, and the elderly with weak physical condition.

　　Second, surgical treatment

　　If the condition does not improve or worsens after non-surgical treatment, surgical treatment should be considered. During surgery, it is advisable to first try manual compression, disperse the ascaris ball, and push it into the large intestine, and then perform deworming treatment the next day. If this fails, intestinal incision and worm removal should be performed. If there is intestinal necrosis, intestinal resection is required; for mild peritoneal infection, peritoneal lavage may not be necessary, but for severe infection, thorough lavage is required. Abdominal drainage may not be necessary when the focus is thoroughly treated.