Surgical complications of Ascaris lumbricoides infestation: A prospective, observational study at a teaching hospital in Butare, Rwanda

  • Ahmed Kiswezi Kazigo
  • Justin Bayisenga
  • Leonard Ndayizeye
  • Julien Gashegu
  • Samuel Kanyesigye
Keywords: Ascaris lumbricoides, surgical complications, Rwanda


Background: Ascaris lumbricoides is a common parasite of the human gut, commonly found in communities with low standards of living in which inappropriate environmental sanitation and poor personal hygiene are common factors accounting for the prevalence of various communicable diseases, including helminths. Many helminthic infestations are sporadic and asymptomatic, affecting individuals, homesteads or a whole community. Heavy infestations, however, often lead to health complications ranging from malnutrition to surgical abdominal complications which occasionally lead to surgical morbidity and mortality. The purpose of this observational study was to document the surgical complications of Ascaris lumbricoides infestation, the commonest nematode helminth found in surgical patients as seen at Butare University Teaching Hospital, over a period of 4 years.

Methods: This was a prospective observational study, documenting all cases as they presented to us with surgical complications associated with Ascaris lumbricoides infestation. The cases in which the parasites were found incidentally during laparotomy were excluded from the study, if their presence had not caused any demonstrable surgical complication prior to surgery. In six of our cases, we were able to make a diagnosis of Ascaris lumbricoides using abdominal imaging (ultrasound and plain abdominal x-ray). All the surgeries were carried out by consultant surgeons, and the operative findings were well documented. All our patients were admitted and the postoperative events were closely followed and documented. Percentages were used to indicate the magnitude of the burden.

Results: Overall, 22 cases were included in the study. They all presented with surgical complications associated with Ascaris lumbriciodes infestation. Small gut obstruction was the commonest complication documented (64%); two patients died of postoperative complications related to bowel resection: short bowel syndrome following extensive small bowel resection; the pediatric population was more vulnerable (>60%). Other complications included biliary system blockage and anastomotic disruption.

Conclusions: Ascaris lumbricoides infestation caused various surgical complications, contributing to surgical morbidity and mortality. Infestation cut across all ages, but the pediatric population was more affected. Pre-operative diagnosis of Ascaris lumbricoides in these patients was possible through good imaging techniques. Surgical morbidity and mortality were related to the type of complication, extent of surgery, and postoperative care.

Original Research