Ascariasis with Paralytic Ileus and Acute Gastroenteritis in a 2-Year-Old Child: A Case Report
Abstract
Ascariasis, caused by Ascaris lumbricoides, is a common soil-transmitted helminth infection among children in developing countries. Severe infestation may cause gastrointestinal complications, including intestinal obstruction and ileus. This case report describes the clinical presentation, diagnostic findings, and management of a pediatric patient with ascariasis complicated by ileus, acute gastroenteritis, dehydration, and electrolyte imbalance.A 2-year-old girl presented with watery diarrhea for three days, vomiting, fever, decreased appetite, and a history of passing worms in her stool. Physical examination revealed a moderately ill appearance, a tympanic abdomen, and decreased bowel peristalsis. Laboratory findings showed eosinophilia, basophilia, hypokalemia at 3.2 mmol/L, and hypochloremia at 93.1 mmol/L. Stool examination revealed watery stool with mucus, 6–11 leukocytes per high-power field, and Ascaris lumbricoides eggs. Abdominal radiography demonstrated dilated small and large bowel loops with a herringbone pattern suggestive of ileus.The patient was diagnosed with ascariasis complicated by ileus, acute gastroenteritis, mild-to-moderate dehydration, and electrolyte imbalance. Management included intravenous rehydration, nasogastric decompression, ondansetron, albendazole 400 mg as a single dose, zinc supplementation, oral rehydration therapy, and empirical ceftriaxone. During hospitalization, gastrointestinal symptoms gradually improved, accompanied by continued passage of worms in the stool.This case emphasizes the importance of prompt diagnosis and comprehensive management of complicated pediatric ascariasis. Hygiene education, environmental sanitation, and regular deworming remain essential to prevent infection and reinfection in endemic areas.
References
Adrizain, R., Nagari, M. V., Sukandar, H., Berbudi, A., Setiabudi, D., & Setiabudiawan, B. (2024). Surveillance of soil-transmitted helminth infection in preschool child population: Do changes in behavior and immunological responses affect prevalence?. Tropical Medicine and Infectious Disease, 9(2), 33. https://doi.org/10.3390/tropicalmed9020033
Ali, A. Y., Abdi, A. M., & Mambet, E. (2023). Small bowel obstruction caused by massive ascariasis: Two case reports. Annals of Medicine and Surgery, 85, 524–527.
Ananthakrishnan, S., & Domachowske, J. B. (2025). Human Infections Caused by Nematodes: Roundworms. In Introduction to Clinical Infectious Diseases: A Problem-Based Approach (pp. 627-657). Cham: Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-84089-0_57
Andleeb, I. G., Rafiq, N., Ateeq-Ur-Rehman, M., Ansari, L., & Ilyas, M. E. (2025). Impact of environmental education on knowledge and hygiene practices among school children in the Potohar Region: a step towards sustainable environmental change. Journal of Asian Development Studies, 14(1), 433-446.
Barrera Sánchez, G., Maqueda Sánchez, Y., & Cetina Castillo, R. A. (2025). Intestinal obstruction caused by Ascaris lumbricoides in a pediatric patient: A case report and literature review. Cureus, 17.
Bąska, P., & Norbury, L. J. (2022). The role of the intestinal epithelium in the “weep and sweep” response during gastro—intestinal helminth infections. Animals, 12(2), 175. https://doi.org/10.3390/ani12020175
Bonvanie, I. J., et al. (2021). Oral ondansetron for paediatric gastroenteritis in primary care: A randomised controlled trial. British Journal of General Practice, 71, e728–e735.
Centers for Disease Control and Prevention. (2024). About ascariasis. Soil-transmitted helminths. Retrieved May 4, 2026, from https://www.cdc.gov/sth/about/ascariasis.html
Collins, N. C., Anike, O. A., Folashade, A. A., Olusesan, A. L., Ibukunolu, O. O., Yetunde, O. O., & Adeola, O. A. (2023). Role of Plain Abdominal X-Ray in the Differential Diagnosis of Common Acute Abdominal Conditions in Children at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. Open Journal of Radiology, 13(3), 125-133. https://doi.org/10.4236/ojrad.2023.133013
Conterno, L. O., Turchi, M. D., Corrêa, I., & Monteiro de Barros Almeida, R. A. (2020). Anthelmintic drugs for treating ascariasis. Cochrane Database of Systematic Reviews, 2020(4), CD010599. https://doi.org/10.1002/14651858.CD010599.pub2
Corvino, D. F. de L., Carmona, S., Tobin, E. H., & Horrall, S. (2026). Ascariasis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430796/
Demir, S., & Haşıloğlu, M. A. (2023). The Impact of Secondary School Students’ Hygiene Habits on Environmental Knowledge. Journal of Computer and Education Research, 11(21), 112-128. https://doi.org/10.18009/jcer.1217819
Diaz, P. J. C., et al. (2024). Adherence to clinical practice guidelines on the management of acute infectious gastroenteritis in children. Acta Medica Philippina, 58, 58–67.
Djohan, P. B., Prasetyadi, A., Wirjanata, M., Widjanarko, N. D., Hengky, A., Wijaya, E., & Astiarani, Y. (2023). Association between Ascaris lumbricoides infection and undernutrition in children: A systematic review and meta-analysis. Bali Medical Journal, 12(1), 197–205. https://doi.org/10.15562/bmj.v12i1.3647
Dworsky, J. Q., & Chen, D. C. (2026). Abdominal Pain, Nausea, and Vomiting. In Surgery: A Case-Based Clinical Review (pp. 25-35). Cham: Springer Nature Switzerland.
Elmi, A. M., Çelik, C., Jama, S. M. A., Dirie, A. M., & Ibrahim, I. G. (2022). Intestinal obstruction in a child with massive ascariasis and associated acute appendicitis. Annals of Medicine and Surgery, 78, 103808.
Farhan, M., Abbas, S. M., Khan, A., Mazhar, S., Zafar, H., Afzoon, S., & Areeba, F. N. U. (2025). Ivermectin-albendazole combination versus ivermectin or albendazole alone in soil transmitted helminthiasis: An updated systematic review and meta-analysis. Acta Tropica, 107859. https://doi.org/10.1016/j.actatropica.2025.107859
Fauziah, N., Aviani, J. K., Agrianfanny, Y. N., & Fatimah, S. N. (2022). Intestinal parasitic infection and nutritional status in children under five years old: a systematic review. Tropical medicine and infectious disease, 7(11), 371. https://doi.org/10.3390/tropicalmed7110371
Fauziah, N., Aviani, J., Agrianfanny, Y. N., & Fatimah, S. N. (2022). Intestinal parasitic infection and nutritional status in children under five years old: A systematic review. Tropical Medicine and Infectious Disease, 7, 371.
G/Kidan, M., Fayisa, S., Hailu, S., & Abebe, A. (2024). Ascariasis: A common disease with uncommon presentation in a resource-limited setting. Radiology Case Reports, 19, 1560–1564.
Gupta, A., Fitzhugh, A., So, C. W., Mehdi, A., Gangi, A., Marshall, M., & Ilangovan, R. (2023). Radiology in Intestinal Failure. In Intestinal Failure (pp. 469-488). Cham: Springer International Publishing.
Hassan, M., Khan, M., Mukti, A., Roy, S., Begum, M., Ferdous, Z., & Yasmeen, B. N. (2022). Electrolyte imbalance in hospitalized children with infections-a tertiary care Experience. Northern International Medical College Journal, 588-593. https://doi.org/10.3329/nimcj.v13i1.73545
Hawa, I. I., & Muslam, M. (2024). Fostering Environmental Hygiene Habits in Children with Special Needs. Atfaluna Journal of Islamic Early Childhood Education, 7(2).
Holland, C. V. (2021). The long and winding road of Ascaris larval migration: The role of mouse models. Parasitology, 148(14), 1735–1743. https://doi.org/10.1017/S0031182021000366
Honcharov, S. L., Kupriianova, O. M., Soroka, N. M., Halat, M. V., Dubovyi, A. I., & Zhurenko, O. V. (2022). The experimental invasion of rats with Eustrongylides excisus (Nematoda, Dioctophymatidae) larvae during the acute course of infection. Regulatory Mechanisms in Biosystems, 13(2), 99-104. https://doi.org/10.15421/022214
Kapur, R. (2023). Understanding The Meaning And Significance Of Personal Hygiene. International Journal of Information, Business and Management, 15(3), 43-52.
Kasiita, M., Businge, S., Napyo, A., & Tumwine, J. K. (2025). Ascaris lumbricoides: Prevalence and associated factors among preschool children. BMC Infectious Diseases, 25, 308.
Kurscheid, J., Laksono, B., Park, M. J., Clements, A. C. A., Sadler, R., McCarthy, J. S., Nery, S. V., Soares-Magalhães, R., Halton, K., Hadisaputro, S., Richardson, A., Indjein, L., Wangdi, K., Stewart, D. E., & Gray, D. J. (2020). Epidemiology of soil-transmitted helminth infections in Semarang, Central Java, Indonesia. PLoS Neglected Tropical Diseases, 14(12), e0008907. https://doi.org/10.1371/journal.pntd.0008907
Kusumasari, R. A., Adi, H., Satoto, T. B. T., Wahab, A., & Murhandarwati, E. E. H. (2025). Malnutrition among children under 7 years of age linked to ascariasis: evidence from West Sumba, Indonesia, despite ongoing deworming program. BMC Public Health, 25(1), 3920. https://doi.org/10.1186/s12889-025-25013-z
Leung, A. K. C., & Hon, K. L. (2021). Paediatrics: How to manage viral gastroenteritis. Drugs in Context, 10, 2020-11-7.
Lloyd, C. M., & Saglani, S. (2023). Early-life respiratory infections and developmental immunity determine lifelong lung health. Nature immunology, 24(8), 1234-1243. https://doi.org/10.1038/s41590-023-01550-w
Loglo, A., Aniagyei, W., Vivekanandan, M. M., Agbanyo, A., Asamoah, E. A., Phillips, R. O., ... & Simmonds, R. E. (2024). A systematic review and meta-analysis of the association between neglected tropical diseases and malnutrition: more research needed on diseases other than intestinal parasites, leishmaniasis and leprosy. Access microbiology, 6(11), 000800-v3. https://doi.org/10.1099/acmi.0.000800.v3
Lu, K., & Xu, G. (2025). Global burden of paralytic ileus and intestinal obstruction in young and middle-aged adults (15–49 years): a systematic analysis from global burden of disease study 2021. European Journal of Medical Research, 30(1), 1129. https://doi.org/10.1186/s40001-025-03384-8
Manavi, M. A., Mohammad Jafari, R., Shafaroodi, H., Sharifzadeh, M., & Dehpour, A. R. (2025). Ivermectin as a promising therapeutic option for onchocerciasis‐associated epilepsy. Epilepsia Open, 10(1), 361-367. https://doi.org/10.1002/epi4.13107
Matsui, R., Nagakari, K., Igarashi, M., Hatta, R., Otsuka, T., Nomoto, J., ... & Ishizaki, Y. (2022). Impact of post-operative paralytic ileus on post-operative outcomes after surgery for colorectal cancer: a single-institution, retrospective study. Surgery today, 52(12), 1731-1740. https://doi.org/10.1007/s00595-022-02499-3
Molla, Y. D., Beza, A. D., Tadesse, A. K., & Answar, I. O. (2023). Ascaris lumbricoides: A rare cause of ileal perforation. International Journal of Surgery Case Reports, 105, 108097.
Morales, F., Montserrat-De la Paz, S., Leon, M. J., & Rivero-Pino, F. (2023). Effects of malnutrition on the immune system and infection and the role of nutritional strategies regarding improvements in children’s health status: a literature review. Nutrients, 16(1), 1. https://doi.org/10.3390/nu16010001
Nadeem, M. F., Butt, A. M., Ashraf, W., Matti, N., Farooq, M. A., Nasim, M. B., ... & Khan, T. M. (2024). The impact of fluid and electrolyte imbalance on the severities of diseases and their management in developing countries. In Handbook of Medical and Health Sciences in Developing Countries: Education, Practice, and Research (pp. 1-20). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-74786-2_30-1
Narayani, D. A., Ali, S., Surja, S. S., Kristin, H., Hengestu, A., Widowati, T. A., ... & Mm, M. K. (2024). Common intestinal parasitic infections in an improved water access, sanitation, and hygiene profile setting in North Jakarta, Indonesia. Narra J, 4(3), e1264. https://doi.org/10.52225/narra.v4i3.1264
Palmer, C. S. (2022). Innate metabolic responses against viral infections. Nature metabolism, 4(10), 1245-1259. https://doi.org/10.1038/s42255-022-00652-3
Poonai, N., et al. (2021). Variables associated with intravenous rehydration and hospitalization in children with acute gastroenteritis. JAMA Network Open, 4, e216433.
Roth‐Walter, F., Berni Canani, R., O'Mahony, L., Peroni, D., Sokolowska, M., Vassilopoulou, E., & Venter, C. (2024). Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients. Allergy, 79(2), 353-383. https://doi.org/10.1111/all.15972
Singh, G., Tucker, E. W., & Rohlwink, U. K. (2022). Infection in the developing brain: the role of unique systemic immune vulnerabilities. Frontiers in Neurology, 12, 805643. https://doi.org/10.3389/fneur.2021.805643
Siviero, I., Almeida, U. V. D., Penna, C. R., Puglia, E. B. D., & Simoes, B. C. B. (2024). Abdominal complications of ascariasis in childhood. Jornal de Pediatria, 100(5), 460-467. https://doi.org/10.1016/j.jped.2024.02.001
Siviero, I., et al. (2024). Abdominal complications of ascariasis in childhood. Jornal de Pediatria, 100, 460–467.
Stracke, K., et al. (2021). Gut microbiome composition of children following mass drug administration for soil-transmitted helminths. PLoS Neglected Tropical Diseases, 15, e0009597.
Sulmiati, Nurmantu, F., Ahmadwirawan, Mariana, N., Habar, T. R., & Faruk, M. (2023). Acute intestinal obstruction due to ascariasis in a child. International Journal of Surgery Case Reports, 104, 107923.
Sun, C., Huang, C., & Yu, C. W. (2023). Environmental exposure and infants health. Indoor and Built Environment, 32(7), 1291-1295. https://doi.org/10.1177/1420326X231154985
Supangat, et al. (2025). Intestinal obstruction due to Ascaris lumbricoides in a child. Journal of Medical Case Reports, 19, 171.
Syahruddin, F. I. (2025). Diagnosing and managing intestinal ascariasis in vulnerable communities. Journal of Health Science, 10(1), 1–8. https://doi.org/10.24929/jik.v10i1.3841
Tapia-Veloz, G., Gozalbo, M., Guirao, V., Dinari, H., Fuentes, M. V., & Trelis, M. (2025). Integrated evaluation of undernutrition, anaemia, and intestinal parasitic infections in school-aged children: a cross-sectional study in three regions of southern Madagascar. Children, 12(8), 990. https://doi.org/10.3390/children12080990
Trasia, R. F. (2023). Epidemiological review: Mapping cases and prevalence of helminthiasis in Indonesia on 2020-2022. International Islamic Medical Journal, 4(2), 37-50. https://doi.org/10.33086/iimj.v4i2.4172
Tsegaye, A. T., Pavlinac, P. B., Walson, J. L., & Tickell, K. D. (2023). The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review. PLOS Global Public Health, 3(11), e0002520. https://doi.org/10.1371/journal.pgph.0002520
Tunali, V., & Korkmaz, M. (2023). Emerging and re-emerging parasitic infections of the central nervous system (CNS) in Europe. Infectious Disease Reports, 15(6), 679-699. https://doi.org/10.3390/idr15060062
Turyasiima, M., et al. (2021). Intestinal obstruction in a child with massive ascariasis. Case Reports in Pediatrics, 2021, 8857291.
Weinstock, J. V., & Leung, J. (2022). Parasitic diseases: helminths. Yamada's Textbook of Gastroenterology, 3039-3078. https://doi.org/10.1002/9781119600206.ch147
Williams, C. (2023). Abdominal pain and GI problems. RCEM Lecture Notes: Emergency medicine, 310-325.
Wulandari, C., Santoso, I., & Erminawati, E. (2025). Hygiene Practices and Scabies Prevalence in a Semi-Urban Indonesian Community: A Case-Control Study Exploring Behavioral and Environmental Determinants in Banjarbaru, South Kalimantan. Global Health & Environmental Perspectives, 2(1), 232-245. https://doi.org/10.61848/ghep.v2i1.134
Yang, M., et al. (2023). Risk factors for hypokalemia and its association with postoperative recovery. BMC Anesthesiology, 23, 285.
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