Small bowel histomorphology in surgical complications of ascariasis: a small series.

BACKGROUND: Ascariasis is a worldwide health problem. Patients usually get treated with antihelminthics. Rarely, undiagnosed cases can present with surgical complications. AIM: To study the clinico-pathological characteristics of small bowel specimens of patients presenting with surgical complications of ascariasis. METHODS: This is a retrospective analysis of small bowel specimens of patients presenting with surgical complications of ascariasis from a period of 2010 to 2012, received in our department. RESULTS: The patients were of all age groups and mainly presented with intestinal obstruction and perforation. Transmural gangrenous change was seen in all nine cases. Encysted ova were seen in five cases. Two of the cases showed partial to complete infarction of isolated mesenteric lymph nodes. CONCLUSION: Ascariasis may cause transmural gangrene of bowel as well as mesenteric lymph node infarction.

Peripheral symmetrical gangrene due to severe Plasmodium falciparum malaria: a case report.

We present a patient with severe Plasmodium falciparum malaria of seven days' duration who developed an altered sensorium of one day. During hospital admission, peripheral symmetrical gangrene of hands and feet followed, despite normal limb vasculature.

Symmetric peripheral gangrene of the lower limbs in a case of complicated falciparum malaria.

Association of symmetric peripheral gangrene (SPG) with falciparum malaria infection is a relatively uncommon clinical entity. Here we report a case of complicated falciparum malaria with SPG involving both lower limbs from the mid-calf downwards, probably due to antibody mediated vasculitis.

Biliary ascariasis presenting with gangrenous perforation of the gall bladder: report of a case and brief review of literature.

The most common cause of gallbladder perforation is calculous cholecystitis. Rarer causes include trauma, iatrogenic injuries, biliary stasis and gall bladder ischemia. We report a case of gall bladder gangrene with perforation, secondary to extensive ascariasis. A 45-year-old woman presented with acute intestinal obstruction and jaundice. She had abdominal distension and right hypochondrial tenderness. Abdominal radiography showed dilated bowel loops and ultrasonogram showed worms in the small intestine and biliary tree. On exploration, a bolus of worms 2 feet proximal to the ileocaecal junction was found causing obstruction. Worms were also present in the bile duct and gallbladder causing gangrene and perforation. She underwent cholecystectomy, bile-duct exploration and enterotomy. However, she died on the third postoperative day of overwhelming sepsis. Enteric complications of ascaris leading to bowel obstruction are well-known. Hepatobiliary complications such as cholangitis and obstructive jaundice are rare. However, such an extreme degree of infestation leading to gangrene and perforation of the gall bladder is extremely rare.

Symmetric peripheral gangrene and falciparum malaria.

Sudden onset symmetric peripheral gangrene (SPG) is a relatively uncommon clinical entity manifested by distal ischemic damage at two or more sites in the absence of large vessel obstruction. Here we report a case of complicated falciparum malaria with rapid onset SPG involving all the toes.

Malaria complicated by gangrene: a case presentation and review.

Symmetrical peripheral gangrene (SPG) is an extremely rare complication of malaria. It occurs acutely and progresses rapidly to cause irreversible necrosis of tissue following which debridement or amputation is inevitable. We present a case of malaria complicated by SPG. A 54-year old male developed SPG two days after he was diagnosed with severe malaria and treated with intravenous quinine. Despite intervention quad-amputation was necessary as the gangrene had involved all four limbs. SPG secondary to malaria is caused by obstruction of arterioles following sequestration of parasite infected erythrocytes. This is extremely rare, hence almost never anticipated during management of malaria patients. Furthermore due to its rapid progression, it is almost always detected at an advanced irreversible stage. Physicians managing malaria should therefore be vigilant, and look out for SPG, as its prognosis is dependent on correct and timely intervention.

Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report.

Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

Gangrene intestine caused by Ascaris lumbricoides; report of 5 cases in children.

Ascaris infestation in the gastrointestinal tract is well known in Asian countries. It can be asymptomatic or can present with symptoms of acute abdomen. Perforation and torsion with gangrene are its very rare fatal complications but an important cause of mortality in children. Although ascariasis is very rare in developed countries, clinicians should consider this potentially dangerous, yet treatable, infection in the differential diagnosis of acute abdomen. We herein report a series of five cases of intestinal gangrene secondary to extensive infestation by Ascaris lumbricoides in children aged 1-4 years.

Diagnosis of Meleney's synergistic gangrene.

A retrospective and comparative study of 127 case reports of Meleney's postoperative progressive synergistic gangrene and of 62 examples of postoperative amoebic skin gangrene, showed that these two entities were clinically indistinguishable and that therefore a purely clinical diagnosis of Meleney's gangrene could not be made. Furthermore, a critical appraisal of the bacteriological data indicated that a certain diagnosis of Meleney's gangrene cannot be provided by the clinical bacteriologist. Finally, the histological features were entirely non-specific thus precluding a definitive diagnosis by the histopathologist. If Meleney's entity cannot be diagnosed its existence becomes debatable. The alternative diagnosis of cutaneous amoebiasis is advanced for consideration. Several of the outstanding features of Meleney's progressive gangrene, hitherto unexplained, are better understood if Entamoeba histolytica is accepted as the prime cause rather than bacteria.

Angiostrongyliasis in a European patient: a rare cause of gangrenous ischemic enterocolitis.

Angiostrongylus costaricensis causes a clinicopathologic disease first observed in Costa Rica, mainly in children characterized by highly symptomatic eosinophilic gastroenteritis involving the terminal ileum, cecum, appendix, and ascending colon. A case of angiostrongyliasis in an adult Spaniard infected during a brief stay in Nicaragua is reported. We examined the macro-microscopic features of a right ileocolic resection of a 52-year-old patient. In the surgical specimen, multiple confluent ulcers, some perforated, were observed particularly in the terminal ileum. The intestinal wall was thickened, and the arterial branches presented necrotizing arteritis with thrombosis and a heavy infiltrate of eosinophils around the vessels. In addition, some granulomas were observed. Adult male and female forms of A. costaricensis were found in the lumen of many arterial branches and in the tissue of the omentum, surrounded by dense eosinophilic infiltrate. A. costaricensis causes an intense eosinophilic, necrotizing arteritis associated with thrombosis leading to severe ischemic lesions. This is the first case to be diagnosed in Europe. Incubation time was able to be established within a period of at least 14 days.

Symmetric peripheral gangrene and falciparum malaria.

Sudden onset symmetric peripheral gangrene (SPG) is a relatively uncommon clinical entity manifested by distal ischemic damage at two or more sites in the absence of large vessel obstruction. Here we report a case of complicated falciparum malaria with rapid onset SPG involving all the toes.