ABSTRACT
Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.
Subject(s)
Duodenal Obstruction/parasitology , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/complications , Adult , Animals , Biopsy , Duodenal Obstruction/diagnostic imaging , Duodenal Obstruction/pathology , Endoscopy, Gastrointestinal/methods , Gastric Mucosa/parasitology , Gastric Mucosa/pathology , HTLV-I Infections/parasitology , Humans , Larva , Male , Strongyloidiasis/pathology , Tomography, X-Ray Computed/methodsABSTRACT
Resumen La estrongiloidiasis es una enfermedad desatendida en Latinoamérica. Las manifestaciones gastrointestinales son inespecíficas y la obstrucción duodenal es una complicación infrecuente. Presentamos el caso clínico de un varón de 31 años, procedente de la selva central de Perú, que ingresó por una obstrucción intestinal alta, con úlceras y una estenosis duodenal evidenciadas en la endoscopia digestiva alta. El informe histopatológico reveló la presencia de larvas de Strongyloides stercoralis. La evolución clínica y endoscópica fueron favorables con el tratamiento con ivermectina. Existen poco más de 20 casos publicados de obstrucción duodenal por S. stercoralis. Adicionalmente, se confirmó una infección por HTLV-1, asociación descrita frecuente.
Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.
Subject(s)
Humans , Animals , Male , Adult , Strongyloidiasis/complications , Strongyloides stercoralis/isolation & purification , Duodenal Obstruction/parasitology , Strongyloidiasis/pathology , Biopsy , HTLV-I Infections/parasitology , Tomography, X-Ray Computed/methods , Endoscopy, Gastrointestinal/methods , Duodenal Obstruction/pathology , Duodenal Obstruction/diagnostic imaging , Gastric Mucosa/parasitology , Gastric Mucosa/pathology , LarvaABSTRACT
BACKGROUND: Strongyloidiasis is a rare helminthic infection in Europe, and it may cause duodenal obstruction. METHODS: We report a patient who was admitted to our Medical Department with nausea and repeated vomiting since 10 years until food intake became impossible. Subsequent investigations revealed a duodenal obstruction at the upper third of the duodenum, as well as enterocolitis of the terminal ileum with eosinophils dispersed throughout the mucosa. Since food intake was still not possible after treatment with a course of i.v. PPI and prokinetic applications, we decided to perform a resection of the upper duodenum with Y-Roux reconstruction. RESULTS: The histopathological examination of the resected specimen revealed strongyloidiasis. CONCLUSION: Parasite infections such as strongyloidiasis represent a rare differential diagnosis of duodenal obstruction especially if patients originate from endemic regions.
Subject(s)
Duodenal Obstruction/parasitology , Strongyloides stercoralis , Strongyloidiasis/complications , Animals , Antiparasitic Agents/administration & dosage , Constriction, Pathologic , Dilatation, Pathologic , Duodenum/parasitology , Duodenum/pathology , Endoscopy, Gastrointestinal , Endosonography , Humans , Ivermectin/administration & dosage , Magnetic Resonance Imaging , Male , Middle Aged , Nausea/parasitology , Stomach/pathology , Strongyloidiasis/diagnosis , Strongyloidiasis/drug therapy , Time Factors , Tomography, X-Ray Computed , Vomiting/parasitologyABSTRACT
Small bowel obstruction due to Strongyloides stercoralis is rare especially in immunocompetent individuals. We report a case of a 45-year-old man who presented with a history of severe abdominal pain, intermittent low-grade fever and vomiting. An upper GI endoscopy revealed a diffusely edematous second portion of duodenum and narrowing in the third part of duodenum with food residue in the stomach. Barium contrast upper-GI radiography revealed partial small-bowel obstruction. Duodenal biopsy specimens revealed Strongyloides stercoralis in the submucosa with inflammatory infiltrate. The patient was treated with ivermectin and had complete resolution of symptoms.
Subject(s)
Duodenal Obstruction/parasitology , Strongyloidiasis/complications , Strongyloidiasis/diagnosis , Antinematodal Agents/therapeutic use , Duodenoscopy , Humans , Ivermectin/therapeutic use , Male , Middle Aged , Photomicrography , Strongyloidiasis/drug therapySubject(s)
Duodenal Obstruction/etiology , Enteritis/complications , HTLV-I Infections/complications , Strongyloides stercoralis , Strongyloidiasis/complications , Adult , Animals , Biopsy , Duodenal Obstruction/diagnosis , Duodenal Obstruction/parasitology , Duodenum/diagnostic imaging , Duodenum/parasitology , Duodenum/pathology , Enteritis/diagnosis , Enteritis/parasitology , Fatal Outcome , HTLV-I Infections/diagnosis , HTLV-I Infections/parasitology , Humans , Male , Radiography , Strongyloidiasis/diagnosis , Strongyloidiasis/parasitologyABSTRACT
Strongyloides stercolaris infestation is rather rare in Iraq. Individuals with infection confined to the intestinal tract are often asymptomatic. Symptoms include abdominal pain, diarrhea, weight loss and other non-specific complaints. The diagnosis depends upon repeated examination of stool and duodenal aspirate. Two cases presenting as sub-acute intestinal obstruction and mimicking primary intestinal lymphoma (PIL) on presentation are presented. Differentiation between the two conditions regarding presenting features, barium studies and pathology are discussed.
