An 83-year-old male, from the department of San Martin (Algeria del Peru), farmer.
She had a history of chronic anemia and an episode of malaria two years ago.
No other relevant medical history.
The clinical picture began two months before admission, with colic pain in mesogastrium, associated with lack of appetite, nausea and vomiting.
Finally, the patient was seen in the Emergency Department due to the intensification of abdominal pain, which extended to the entire abdomen, associated with uncontrollable vomiting, with no elimination of gases and stools.
On physical examination, he was complaining of tachycardia and jaundiced scleras.
Auscultation revealed arrhythmic heart sounds of normal intensity.
In the abdominal examination the air-fluid sounds were diminished, the abdominal wall was soft, depressible and painful diffusely.
No visceromegaly was evident.
The rest of the physical examination was considered non-contributory.
Having suspected a possible intestinal obstruction, a simple abdominal X-ray of the foot showed dilation of the intestinal loops with the presence of multiple air-fluid levels.
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Laboratory tests included a blood count with hemoglobin 15.3 g/dL, hematocrit 44%, 11,570 leucocytes/mm3, segmented 81%, no bacilliforms or eosinophils, CRP of 386 mg/L, hyperalbumin/UGT
Serology for HIV, HTLV 1-2 and HCV were negative.
HBsAg and RPR were also negative.
An emergency exploratory laparotomy was performed due to a probable mechanical intestinal obstruction.
Intraoperative findings showed a dilated small intestine loops with linear forms suggestive of A. lumoides on its surface.
At that time, the decision was made to treat the patient with abdominal wall closure.
The postsurgical clinical evolution was unfavorable.
The patient evolved into hypovolemic shock, spontaneous and massive exit of adult worms through the oral cavity and nostrils.
It was decided to perform an emergency surgical re-intervention, which showed a large dilation of the intestinal loops, with abundant quantity of adult specimens, with multiple areas of aglomeration in the form of intestinal lumen, which or
An enterotomy was performed at the level of the ileum, 40 cm from the ileocecal valve, with extraction of 20 worms.
The intestinal loops were ordained, from the Treitz angle to the enterotomy, eliminating abundant amount of bowel movements.
A clear serous fluid was observed in the abdominal cavity.
The cecal appendix and gallbladder had normal characteristics.
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After the first surgery, antiparasitic treatment with albendazole was initiated.
However, the clinical evolution was unsatisfactory, requiring the second surgical intervention, ventilatory support and management in the Intensive Care Unit (ICU).
During his stay in the ICU, the patient presented with a pneumonia associated with mechanical Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii bacteremia.
The elimination of adult worms through the oral cavity continued for several days after the last surgery.
