Worm Bolus
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B77 DESCRIPTION Partial or complete obstruction of the bowel by a 'knot' of Ascaris lumbricoides curled around each other. Usually presents with cramping abdominal pain with/without other evidence of obstruction. May occasionally lead to local necrosis and perforation of the small bowel.
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: B77
DESCRIPTION
Partial or complete obstruction of the bowel by a 'knot' of Ascaris lumbricoides curled around each other. Usually presents with cramping abdominal pain with/without other evidence of obstruction. May occasionally lead to local necrosis and perforation of the small bowel.
DIAGNOSTIC CRITERIA
Clinical
Cramping abdominal pain associated with/without a palpable worm mass which may also be identified on X-ray abdomen straight or with contrast (when considered safe).
Exclusion of other causes of acute abdomen or acute abdominal pain.
GENERAL AND SUPPORTIVE MEASURES
- Maintain fluid, electrolyte and nutritional needs - IV route may be needed.
- Nil per mouth and free drainage, where clinically indicated.
- Observe for failure of resolution, complete obstruction or evidence of necrosis/perforation.
- Surgery for complete obstruction, evidence of necrosis or perforation.
- Identify possible iron deficiency.
- Be alert for possible worm aspiration.
MEDICINE TREATMENT
Once the bolus resolves treat the ascaris:
Children 1–2 years of age:
- Mebendazole, oral, 100 mg 12 hourly for 3 days.
Children > 2 years:
- Mebendazole, oral, 500 mg as a single dose immediately.
REFERRAL
- Inability to manage surgical problems, if present.
- Obstruction not relieved after 48 hours.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 2: Alimentary Tract, 2.6 Worm Bolus