title: Intestinal ascariasis at pediatric emergency room in a developed country.
abstract: Ascaris lumbricoides infection is rare among children in developed countries. Although large numbers of adult Ascaris in the small intestine can cause various abdominal symptoms, this infection remains asymptomatic until the number of worms in the intestine considerably increases in most cases. Ascaris causing bilious vomiting suggesting ileus is rare, especially in developed countries. A 6-year-old boy who lived in Japan, presented with abdominal colic, bilious vomiting at the pediatric emergency room. He appeared pale, and had no abdominal distention, tenderness, palpable abdominal mass, or findings of dehydration. He experienced bilious vomiting again during a physical examination. Laboratory tests showed mild elevation of white blood cells and C-reactive protein levels. Antigens of adenovirus, rotavirus, and norovirus were not detected from his stool, and stool culture showed normal flora. Ultrasonography showed multiple, round-shaped structures within the small intestine, and a tubular structure in a longitudinal scan of the small intestine. Capsule endoscopy showed a moving worm of Ascaris in the jejunum. Intestinal ascariasis should be considered as a cause of bilious vomiting in children, even at the emergency room in industrial countries. Ultrasound examination and capsule endoscopy are useful for diagnosis of pediatric intestinal ascariasis.
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umetsu
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sogo
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwasawa
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tsunoda
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Manari
authors.initials: M
authors.lastname: Oikawa-Kawamoto
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Ayano
authors.initials: A
authors.lastname: Inui
authors.affiliation: Shuichiro Umetsu, Tsuyoshi Sogo, Kentaro Iwasawa, Takeo Kondo, Tomoyuki Tsunoda, Manari Oikawa-Kawamoto, Ayano Inui, Tomoo Fujisawa, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, Kanagawa 230-0012, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Fujisawa
mesh_terms: D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use; D001196:Ascariasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D017164:Ascaris lumbricoides / Q000187:drug effects / Q000302:isolation & purification*; D053704:Capsule Endoscopy; D002648:Child; D004636:Emergency Service, Hospital; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D007418:Intestinal Pseudo-Obstruction / Q000469:parasitology; D007564:Japan; D007583:Jejunum / Q000000981:diagnostic imaging / Q000187:drug effects / Q000469:parasitology*; D008297:Male; D011237:Predictive Value of Tests; D011716:Pyrantel Pamoate / Q000627:therapeutic use; D016896:Treatment Outcome; D014463:Ultrasonography; D014839:Vomiting / Q000469:parasitology
chemical_list: D000969:Antinematodal Agents; D011716:Pyrantel Pamoate
keywords: Ascaris lumbricoides; Bilious vomiting; Capsule endoscopy; Paralytic ileus; Ultrasound