Laparotomy Due To Ascaris Lumbricoides   at A.I.C Litein Mission Hospital – Kenya.

Background: Ascariasis is known to be a cause of intestinal obstruction particularly in children. This study was aimed at determining the burden of Ascaris lumbricoides (round worms) in as a cause of mechanical intestinal obstruction requiring laparotomy for treatment in a rural setting.
Methods: The study was a 5-Year (2001-2005) descriptive retrospective study of cases of mechanical intestinal obstruction caused by mechanical blockage by Ascaris lumbricoides A.I.C Litein Mission Hospital, Kenya.
Results: During the study period under review, a total of 582 abdominal operations were performed. In 69 (12%) of the patients the indication was intestinal obstruction caused by Ascaris lumbricoides. Their ages ranged from 3 months to 44years.This accounted for 12% of abdominal operations. The majority (94%) of these patients were aged 10 years or less. Among children aged 10 years and below, ascariasis intestinal obstruction was the commonest indication for laparotomy, contributing 33.5% of the 161 laparotomies done; it was followed by intussusception. The commonest symptoms were abdominal pains (81%), vomiting (58%) and constipation (64%) with an average duration of 3 days. The commonest physical findings included abdominal mass (75%), toxic appearance (58%) and dehydration (54%).Worm impaction was found in 96% of the patients, peritonitis in 13% and gut necrosis in 6%. The commonest procedure carried out was enterotomy and worm removal (90%). No death was recorded. The average length of hospital stay was 8 days with an average cost of treatment of Ksh.28, 916 (US $ 596).
Conclusion: Ascaris lumbricoides is still a major cause of intestinal obstruction in children. This is an expensive surgical problem that can otherwise be prevented by improved sanitation and appropriate public health intervention. Clinical diagnosis remains the mainstay of diagnosis in the rural setting.