Small bowel obstruction due to ascariasis in a child from southern Ethiopia: a case report

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BACKGROUND: Ascariasis, caused by the parasitic nematode Ascaris lumbricoides, is estimated to affect just under 900 million people globally, the majority of whom are children. Infections are most common in impoverished regions with poor water, sanitation, and hygiene, as transmission is reliant upon the ingestion of eggs excreted in feces found in contaminated soil. CASE PRESENTATION: An 8-year-old Black African boy from the Sidama region, southern Ethiopia, presented at Adare General Hospital with a 3-day history of vomiting, abdominal pain, distension, and inability to pass stool or gas. Ultrasound confirmed a small bowel obstruction caused by a bolus of A. lumbricoides, which was successfully removed by surgical intervention via laparotomy and enterotomy. Postoperative treatment included the administration of anthelmintics and antibiotics, which led to stable recovery, with normal bowel function observed 1 month after surgery. The child's socioeconomic status, environmental conditions, and lack of knowledge about ascariasis transmission likely contributed to this severe infection, leading to the occurrence of the small bowel obstruction. Critically, his family lacked sanitation facilities, practiced open defecation, and consumed untreated surface water. The family did not participate in recent mass drug administration campaigns and had poor awareness of hygiene practices, highlighting gaps in the current national neglected tropical disease control program and deficiencies in public health education. CONCLUSION: Despite Ethiopia's national deworming program being in existence since 2015, the lack of adequate water, sanitation, and hygiene infrastructure and awareness of risk-reducing behaviors, including participation in mass drug administration campaigns, has culminated in the continuation of A. lumbricoides transmission in many communities in Ethiopia. Enhanced mass drug administration coverage and robust water, sanitation, and hygiene interventions are the major goals of efforts in Ethiopia to reduce the national worm burden and prevent occurrence of severe complications such as small bowel obstruction caused by significant build-up of worms. As the presented case highlights, continuous community health education is essential for long-term control, as it increases mass drug administration participation and emphasizes the importance of good hygiene practices within communities. Fine-scale parasitological mapping and regular epidemiological assessments are necessary to identify high-risk families and communities and implement necessary treatment strategies.

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