|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Abdominal pain and 14 weeksFrom: Terrence.Jones@ncal.kaiperm.orgThu Oct 24 21:20:50 1996
Geez, Ricardo, sometimes I think I've got it bad... I'd echo the other responses, and guess it was intestinal ascariasis. Marco Villar, from nearby Honduras, tho stationed with Dr. Sibai at Memphis at the time, published on biliary complications of ascaris in Am J Ob/Gyn 2/92, vol 166:549-50. He points out the prevalence of the nematode worldwide (1 billion), as well as the US (4 million). The accompanying sono demonstrates the findings also described by Khuroo et al in J Clin Ultrasound 11-12/92, vol 20:587-91. The worm appears in the gall bladder of 2% of biliary infesta- tions, as a 'non-shadowing echogenic coil with anechoic (central) tubular lumen'. The author suggests biliary dilation secondary to maternal hormonal effects might facilitate migration. Back to Dr Villar's paper, there's a well summarized discussion of treatment during pregnancy (Pyrantel pamoate {anti- minth} is preferred) based on the findings of the large sample provided by Heinonen ("Birth defects and drugs in Pregnancy." Littleton, Mass (1977), pg 297.) In addition, piperazine sulfate was also shown to have no adverse fetal effects. I guess the lesson for those in the US, as 25% of the world's pop carries this bug, we should watch for manifestations in pregnant travelers from equatorial regions, and strongly consider positive stool O&P, rather than delaying until postpartum (Postgrad Med 1/93, vol 93:171-3). Another thing to consider, in endemic areas, is the relatively high re-infection rate (near 80% on 2nd, 3rd courses) - see Lancet 5/92, 339:1253-7. Intestinal obstruction occurs in 2/1000 (fatal in 6/100,000 children) according to Teitze (Primary Care 3/91, vol 18:25-41). As Dr. Nagey mentioned, plain films of the abd may be useful, demonstrating a "whirlpool pattern in most cases"; in the study by Villamizar describing 88 children with intestinal obstruction secondary to ascaris (J Ped Srug 1/96, vol 312:201-4), between 1984-94. The presentation was sub-acute in 75%, but the remaining 25% presented as acute abdomen. 23 pts went to the OR, with 11 requiring 'milking' of the nematodes from the distal ileum into the colon; 6 required resection and reanastomosis, 6 had APPY - 2 of which revealed ascaris in the terminal ileum/cecum. Those with acute presentation demonstrated fever, dehydration, nausea & vomiting, abd pain and distention. If biliary disease is suspected (12 cases described by Karim in Int J Surg, Jan-Mar 91, vol 76: 27-9), duct exploration is recommended with the possibility of "STRONG SUCTION" (!) being required to convince the nematodes to leave. More severe intestinal sequelae have also been described, for instance perforation and granulomatous peritonitis were noted in a case per Mello (J Ped Surg 9/92, vol 27: 1229-30). Holcombe also points out assoc immunologic conditions (HIV) that might aggravate the condition (Gut 1/95, 36:9-11). Lastly, regarding fetal response, there is evidence of intrauterine infection, bases on IgM in paired cord blood samples, noted in a study in Acta Ped Scand 12/91, 80:1134-80). Best of luck with a very difficult case, the problems seem to be only starting... Terry Jones, San Fran
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:19:45 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.