Wandering Ascaris Coming Out Through the Abdominal Wall
A 40-year-old female had undergone dilatation and curettage for missed abortion by a quack. On the second day she developed abdominal pain in the periumblical area which later on involved the whole abdomen. Pain was followed by abdominal distension and fever. There was no history of nausea, vomiting, hemetemesis, malena. There was history of anorexia.\nPhysical examination revealed an ill-looking female with pulse of 100 bpm, blood pressure of 100/60 and temperature of 100°F. Abdominal examination showed guarding and rebound tenderness all over. Chest and cardiovascular examination was essentially normal.\nChest X-ray of both domes of the diaphragm showed gas under the diaphragm. Abdominal sonography showed free fluid in the peritoneal cavity. A diagnosis of peritonitis was made and patient was explored. Operative findings were:\nFour perforations in the ileum in a segment of about 15 cm. About 300 ml of dirty bile-stained fluid in the peritoneal cavity. Pus flakes were present all over.\nResection anastomosis of the ileum was done and patient was put on Ryle's tube, IV fluids, and IV antibiotics (ceftrioxone salbactum and tinidazole). Ryle's tube was removed on the third postoperative day. Patient was shifted to liquid orals on the fifth postoperative day. Patient developed pus discharge from wound. Swab culture sensitivity was sterile. Skin sutures were removed and pus was drained. Wound was dressed daily and healing was achieved by secondary intention. On the 10th postoperative day patient developed a fistula just below the umbilicus which drained a small amount of bile-stained fluid, about 20 ml/day. On the 12th postoperative day a 10-cm-long worm was seen coming out through the fistulous tract. Discharge from the fistula decreased subsequently. Fistula closed of its own after three days. Wound healed completely by secondary intention. Patient was administered 400 mg of Albandazole for three consecutive days. Patient is on follow-up for the last six months.