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Intestinal ascariasis

Intestinal ascariasis ultrasound case study

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Reporting Panel

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Colun Pathology

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USG

Intestinal ascariasis ultrasound case study

CASE–1

Clinical History

A 28-year-old patient presented with intermittent colicky abdominal pain, abdominal distension, nausea, vomiting, poor appetite, and passage of worms in the stool. The patient was referred for abdominal ultrasound to evaluate suspected intestinal ascariasis and exclude bowel obstruction.

Ultrasound Findings

Ultrasound examination demonstrates multiple elongated linear echogenic tubular structures within the lumen of the small bowel, some showing a central longitudinal anechoic tube ("inner tube" or "railway track" sign), consistent with Ascaris lumbricoides. Mild fluid-filled bowel loops are present without significant bowel wall thickening. No evidence of bowel obstruction, bowel perforation, intussusception, free intraperitoneal fluid, or localized abscess is identified. No worms are visualized within the biliary tree on the current examination.

Ultrasound of the small bowel. Multiple elongated echogenic tubular structures with a central anechoic channel ("railway track" or "inner tube" sign) are visualized within the bowel lumen, consistent with intestinal ascariasis.

Report Line

Multiple elongated echogenic tubular structures with central longitudinal anechoic channels are demonstrated within the lumen of the small bowel, consistent with intestinal Ascaris lumbricoides infestation. No evidence of bowel obstruction, perforation, intussusception, free intraperitoneal fluid, or localized abscess is identified. No sonographic evidence of biliary ascariasis is seen on the current examination.

Impression

Features are consistent with intestinal ascariasis (Ascaris lumbricoides infestation) without sonographic evidence of bowel obstruction or other acute complications.

Recommendation

Clinical correlation and stool examination for ova and parasites are recommended. Appropriate antihelminthic therapy (e.g., albendazole or mebendazole) should be initiated as clinically indicated. Follow-up ultrasound may be considered if symptoms persist or if complications such as bowel obstruction or biliary migration are suspected.

Key Learning Points

• Ascaris lumbricoides is the most common intestinal helminth affecting humans.
• On ultrasound, intestinal worms appear as elongated echogenic tubular structures with a central anechoic tube ("inner tube" or "railway track" sign).
• Multiple worms may produce the "bag of worms" appearance within dilated bowel loops.
• Ultrasound is useful for detecting living worms and associated complications such as bowel obstruction, intussusception, or biliary ascariasis.
• Stool microscopy remains the standard laboratory test for confirming intestinal ascariasis.
• Albendazole or mebendazole are the first-line antihelminthic treatments.
• Heavy worm infestation may lead to intestinal obstruction, volvulus, perforation, pancreatitis, or biliary obstruction requiring urgent management.