Review Article

The Helminths Causing Surgical or Endoscopic Abdominal Intervention: A Review Article


Background: Helminths sometimes require surgical or endoscopic intervention. Helminths may cause acute abdomen, mechanical intestinal obstruction, gastrointestinal hemorrhage, perforation, hepatitis, pancreatitis, and appendicitis. This study aimed to determine the surgical diseases that helminths cause and to gather, analyze the case reports, case series and original articles about this topic in literature.

Methods: This study was designed as a retrospective observational study. In order to determine the studies published in literature, the search limits in PubMed database were set to 1 Jan 1957 and 31 Mar 2016 (59 yr), and the articles regarding Helminth-Surgery-Endoscopy were taken into examination. Among 521 articles scanned, 337 specific ones were involved in this study.

Results: The most common surgical pathology was found to be in Ascaris lumbricoides group. Enterobius vermicularis was found to be the parasite that caused highest amount of acute appendicitis. Anisakiasis was observed to seem mainly because of abdominal pain and mechanical intestinal obstruction. Strongyloides stercoraries causes duodenal pathologies such as duodenal obstruction and duodenitis. Taenia saginata comes into prominence with appendicitis and gastrointestinal perforations. Fasciola hepatica exhibits biliary tract involvement and causes common bile duct obstruction. Hookworms were observed to arise along with gastrointestinal hemorrhage and anemia. Trichuris trichiuria draws attention with gastrointestinal hemorrhage, mechanical intestinal obstruction.

Conclusion: Helminths may lead to life-threatening clinic conditions such as acute abdomen, gastrointestinal perforation, intestinal obstruction, and hemorrhages. There is a relationship between surgery and helminths. It is very important for surgeons to consider and remember helminths in differential diagnoses during their daily routines.

Simpson WG, Gerhardstein DC, Thompson JR. Disseminated Strongyloides stercoralis infection. South Med J. 1993 ;86(7):821-5.

Patel G, Arvelakis A, Sauter BV et al. Strongyloides hyperinfection syndrome after intestinal transplantation. Transpl Infect Dis. 2008;10(2):137-41.

Sandouk F, Haffar S, Zada MM et al. Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastroenterol. 1997; 92(12):2264-7.

Jaboury IA. Role of Enterobius vermicu-laris in appendicitis in children. ANZ J Surg. 2015;85(7-8):594.

Schuster R, Petrini JL, Choi R. Anisakiasis of the colon presenting as bowel obstruction. Am Surg. 2003;69(4):350-2

Efem SE. Ascaris lumbricoides and intestinal perforation. Br J Surg. 1987;74(7):643-4.

Isik B, Yilmaz M, Karadag N et al. Appendiceal Enterobius vermicularis infestation in adults. Int Surg. 2007;92(4):221-5.

Daneshbod Y, Daneshbod K, Negahban S et al. Intraoperative touch imprint diagnosis of Strongyloides stercoralis infection mimicking a malignant tumor. Acta Cytol. 2008;52(3):387-9.

Mineta S, Shimanuki K, Sugiura A et al. Chronic anisakiasis of the ascending colon associated with carcinoma. J Nippon Med Sch. 2006;73(3):169-74.

Setia U, Bhatia G. Pancreatic cystadenocarcinoma associated with Strongyloides. Am J Med. 1984; 77(1):173-5.

Mangiavillano B, Carrara S, Petrone MC et al. Ascaris lumbricoides-Induced Acute Pancreatitis: Diagnosis during EUS for a Suspected Small Pancreatic Tumor. JOP. 2009;10(5):570-2.

Khuroo MS, Zargar SA. Biliary ascariasis. A common cause of biliary and pancreatic disease in an endemic area. Gastroenterology. 1985; 88(2):418-23.

Javid G, Wani NA, Gulzar GM et al. Ascaris-induced liver abscess. World J Surg. 1999;23(11):1191-4.

Bari S, Sheikh KA, Ashraf M et al. Ascaris liver abscess in children. J Gastroenterol. 2007;42(3):236-40.

Kumar P, Yadav S, Saini S et al. A rare cause of intraoperative nasogastric tube obstruction. J Postgrad Med. 2013;59(4):331-2.

Kiafar C, Shah D, Wadas D et al. Intermittent obstruction of jejunostomy tube due to Ascaris lumbricoides infection. South Med J. 2008;101(6):654-6.

Wani I. Gallbladder ascariasis. Turk J Gastroenterol. 2011;22(2):178-82.

Tomás A, Vida F, Puig X. Presence of Ascaris lumbricoides in the esophagus and stomach: an exceptional endoscopic observation Gastroenterol Hepatol. 1997;20(6):335.

Tay KV, Teo JY. Education and imaging. Gastrointestinal: Incidental findings of Ascaris lumbricoides in patient presenting with ureteric colic. J Gastroenterol Hepatol. 2012;27(6):1127.

Schulze SM, Chokshi RJ, Edavettal M et al. Acute abdomen secondary to Ascaris lumbricoides infestation of the small bowel. Am Surg. 2005;71(6):505-7.

Mosiello G, Adorisio O, Gatti C et al. Ascariasis as a cause of acute abdomen: a case report. Pediatr Med Chir. 2003;25(6):452-4.

Fenger JR. Surgical complications of ascariasis. Ann Surg. 1957;146(6):983-9.

Villamizar E, Méndez M, Bonilla E et al. Ascaris lumbricoides infestation as a cause of intestinal obstruction in children: experience with 87 cases. J Pediatr Surg. 1996;31(1):201-4; discussion 204-5.

Fontan AN, Gimenez E, Wynbergh W, Gatto LA, Novello R. Upper digestive hemorrhage caused by Ascaris lumbricoides in the duodenum Acta Gastroenterol Latinoam. 1984;14(1):85-7.

Goyal N, Khurana N. Acute jejunal gangrene with perforation due to Ascaris lumbricoides. Trop Gastroenterol. 2012;33(1):85-6.

Ariyarathenam AV, Nachimuthu S, Tang TY et al. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg. 2010;8(6):466-9.

Debek W, Dzienis-Koronkiewicz E, Hermanowicz A et al. Oxyuriasis-induced intestinal obstruction in a child--case report. Rocz Akad Med Bialymst. 2003;48:115-7.

Daly JJ, Baker GF. Pinworm granuloma of the liver. Am J Trop Med Hyg. 1984;33(1):62-4.

Tsung SH, Loh WP. Invasion of the Fallopian tube by Enterobius vermicularis. Ann Clin Lab Sci. 1979;9(5):393-5.

Abramson DJ. Acute appendicitis and a Meckel's diverticulum with Enterobius vermicularis. First reported case. Am Surg. 1966;32(5):343-6.

Jurado-Palomo J, López-Serrano MC, Moneo I. Multiple Acute Parasitization by Anisakis simplex. J Investig Allergol Clin Immunol. 2010;20(5):437-41.

Mineta S, Shimanuki K, Sugiura A et al. Chronic Anisakiasis of the Ascending Colon Associated with Carcinoma. J Nippon Med Sch. 2006 ;73(3):169-74.

Schuster R, Petrini JL, Choi R. Anisakiasis of the colon presenting as bowel obstruction. Am Surg. 2003;69(4):350-2.

Kojima G, Usuki S, Mizokami K et al. Intestinal anisakiasis as a rare cause of small bowel obstruction. Am J Emerg Med. 2013;31(9):1422.e1-2.

Matsuo S, Azuma T, Susumu S et al. Small bowel anisakiosis: a report of two cases. World J Gastroenterol. 2006;12(25):4106-8.

Takamizawa Y, Kobayashi Y. Adhesive intestinal obstruction caused by extragastrointestinal anisakiasis. Am J Trop Med Hyg. 2015;92(4):675-6.

Filauro M, Rollandi GA, Cassola G et al. Gastrointestinal bleeding due to suspected anisakiasis: challenging differential diagnosis for a rare disease. Updates Surg. 2011;63(3):213-7.

Sashiyama H, Fu KI, Hoshino T et al. Education and imaging: Gastrointestinal: gastric anisakiasis presenting as a submucosal tumour diagnosed by endoscopic submucosal dissection. J Gastroenterol Hepatol. 2010;25(11):1806.

Marzocca G, Rocchi B, Lo Gatto M et al. Acute abdomen by anisakiasis and globalization. Ann Ital Chir. 2009;80(1):65-8.

Song TJ, Cho SW, Joo KH. Endoscopic findings of acute gastric anisakiasis - Thirty-nine cases in Inchon City .Korean J Gastrointest Endosc 1999;19:878-884.

Sugita S, Sasaki A, Shiraishi N et al. Laparoscopic treatment for a case of ileal anisakiasis. Surg Laparosc Endosc Percutan Tech. 2008;18(2):216-8

Kojima K, Koyanagi T, Shiraki K. Pathological study of anisakiasis (parasitic abscess of the digestive tract). Nihon Rinsho. 1966;24(12):2314-23.

Pampiglione S, Rivasi F, Criscuolo M. Human anisakiasis in Italy: a report of eleven new cases. Pathol Res Pract. 2002; 198(6):429–34.

Ortega-Deballon P, Carabias-Hernández A, Martín-Blázquez A et al. Anisakiasis: an infestation to be known by surgeons. Ann Chir. 2005;130(6-7):407-10.

Garcia-Perez JC, Rodríguez-Perez R, Ballestero A et al. Previous Exposure to the Fish Parasite Anisakis as a Potential Risk Factor for Gastric or Colon Adenocarcinoma. Medicine (Baltimore). 2015; 94(40):e1699.

Lee EJ, Kim YC, Jeong HG et al. The mucosal changes and influencing factors in upper gastrointestinal anisakiasis: analysis of 141 cases. Korean J Gastroenterol. 2009;53(2):90-7.

Kakati B, Dang S, Heif M et al. Strongyloides duodenitis: case report and review of literature. J Natl Med Assoc. 2011;103(1):60-3.

Juchems MS, Niess JH, Leder G et al. Strongyloides stercoralis: a rare cause of obstructive duodenal stenosis. Digestion. 2008;77(3-4):141-4.

Bannon JP, Fater M, Solit R. Intestinal ileus secondary to Strongyloides stercoralis infection: case report and review of the literature. Am Surg. 1995;61(4):377-80.

Bhatt BD, Cappell MS, Smilow PC et al. Recurrent massive upper gastrointestinal hemorrhage due to Strongyloides stercoralis infection. Am J Gastroenterol. 1990; 85(8):1034-6.

Makker J, Balar B, Niazi M et al. Strongyloidiasis: a case with acute pancreatitis and a literature review. World J Gastroenterol. 2015;21(11):3367-75.

Mazhar M, Ali IA, Agudelo Higuita NI. Strongyloides Hyperinfection in a Renal Transplant Patient: Always Be on the Lookout. Case Rep Infect Dis. 2017;2017:2953805.

Abanyie FA, Gray EB, Delli Carpini KW et al. Donor-derived Strongyloides stercoralis infection in solid organ transplant recipients in the United States, 2009-2013. Am J Transplant. 2015;15(5):1369-75.

Sethi S, Kheraj R, Sethi N et al. Images of the month: A case of strongyloidiasis presenting as a colonic mass. Am J Gastroenterol. 2014;109(1):20.

Sridhara S, Simon N, Raghuraman U et al. Strongyloides stercoralis pancolitis in an immunocompetent patient. Gastrointest Endosc. 2008;68(1):196-9.

Bekraki A, Hanna K. Peritonitis caused by jejunal perforation with Taenia saginata: report of a case. J Parasit Dis. 2016;40(1):203-4.

Karatepe O, Adas G, Tukenmez M et al. Parasitic infestation as cause of acute appendicitis. G Chir. 2009;30(10):426-8.

Uygur-Bayramiçli O, Ak O, Dabak R et al. Taenia saginata a rare cause of acute cholangitis: a case report. Acta Clin Belg. 2012;67(6):436-7.

Triest L, Mana F, Willekens I et al. Ob-structive jaundice at the age of 24. Fasciola hepatica. Acta Gastroenterol Belg. 2014;77(2):272-3.

Kim AJ, Choi CH, Choi SK et al. Ectopic Human Fasciola hepatica Infection by an Adult Worm in the Mesocolon. Korean J Parasitol. 2015;53(6):725-30.

Miranda A, Frost F, Golledge C et a. An unexpected finding of Fasciola hepatica in an FNA of a liver mass. Cytopathology. 2015;26(4):259-60.

Chen YY, Soon MS. Endoscopic diagnosis of hookworm infection that caused intestinal bleeding. Gastrointest Endosc. 2005;62(1):142.

Lintermans JP. Severe intestinal bleeding leading to exploratory laparotomy in an infant with hookworm infection. Clin Pediatr (Phila). 1976;15(11):1073–4.

el Shazly AM, Handousa AE, Ibrahem MI. Histochemical and pathological studies on biopsied materials from patients with Ancylostoma duodenale infection. J Egypt Soc Parasitol. 1998;28(3):665-72.

Fishman JA, Perrone TL. Colonic obstruction and perforation due to Trichuris trichiura. Am J Med 1984; 77: 154-156.

Hung HC, Jan SE, Cheng KS, Chu KC, Chien TC. Gastrointestinal bleeding due to whipworm (Trichuris trichiura) infestation. A case report. Chin Med J 1995; 55: 408-411.

Kanoksil W, Larbcharoensub N, Soontrapa P et al. Eosinophilic appendicitis caused by Schistosoma japonicum: a case report and review of the literature. Southeast Asian J Trop Med Public Health. 2010;41(5):1065-70.

Agarwal R, Khanna D, Barthwal SP. Microfilariae in a cytologic smear from cavernous hemangioma of the liver. A case report. Acta Cytol. 1998;42(3):781-2.

Vij M, Kumari N, Krishnani N. Microfilaria in liver aspiration cytology: an extremely rare finding. Diagn Cytopathol. 2011;39(7):521-2.

Kröner PT, Argueta V. Abdominal angiostrongyliasis mimicking acute appendicitis. Endoscopy. 2015;47 Suppl 1 UCTN:E179-80.

Sahel J, Bastid C, Choux R. Biliary ascariasis combined with a villous tumor of the papilla. Diagnostic and therapeutic value of endoscopy. Endoscopy. 1987;19(6):243-5.

Rogers WA Jr, Nelson B. Strongyloidiasis and malignant lymphoma. "Opportunistic infection" by a nematode. JAMA. 1966 ;195(8):685-7.

Lee SC, Hwang KP, Tsai WS et al. Detection of Enterobius vermicularis eggs in the submucosa of the transverse colon of a man presenting with colon carcinoma. Am J Trop Med Hyg. 2002;67(5):546-8.

Virgone C, Cecchetto G, Besutti V et al. Bowel parasitosis and neuroendocrine tumours of the appendix. A report from the Italian TREP project. Epidemiol Infect. 2015;143(7):1552-5.

Sonoda H, Yamamoto K, Ozeki K et al. An Anisakis larva attached to early gastric cancer: report of a case. Surg Today. 2015;45(10):1321-5.

Jaiswal S, Chand G, Lal H et al. Microfilaria in association with adrenal lymphoma diagnosed on cytology: an extremely rare case report. Turk Patoloji Derg. 2013;29(2):143-5.

Vennervald BJ, Polman K. Helminths and malignancy. Parasite Immunol. 2009; 31(11):686-96.

Fried B, Reddy A, Mayer D. Helminths in human carcinogenesis. Cancer Lett. 2011;305(2):239-49.

Ozsarlak O, De Schepper AM, De Backer A et al. Diagnostic and therapeutic role of ERCP in biliary ascariasis. Rofo. 1995;162(1):84-5.

Yoshihara S, Toyoki Y, Takahashi O et al. Laparoscopic treatment for biliary ascariasis. Surg Laparosc Endosc Percutan Tech. 2000;10(2):103-5.

Do KR, Cho YS, Kim HK et al. Intestinal helminthic infections diagnosed by colonoscopy in a regional hospital during 2001-2008. Korean J Parasitol. 2010;48(1):75-8.

Kalkan İH, Köksal AŞ, Öztaş E et al. Endoscopic removal of an immigrant (Taenia saginata) from the stomach of a geriatric patient. Geriatr Gerontol Int. 2013;13(1):232-3.

Ozer B, Serin E, Gümürdülü Y et al. Endoscopic extraction of living Fasciola hepatica: case report and literature review. Turk J Gastroenterol. 2003;14(1):74-7.

Reddy SC, Vega KJ. Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointest Endosc 2008; 67(6):990-2.

Sauer PE, Murdock CE Jr, Erwin JH et al. The surgeon and the worm. Arch Surg. 1968;97(4):595-600.

IssueVol 12 No 2 (2017) QRcode
SectionReview Article(s)
Helminths Surgery Ascaris Endoscopy Enterobius Taenia

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UYSAL E, DOKUR M. The Helminths Causing Surgical or Endoscopic Abdominal Intervention: A Review Article. Iran J Parasitol. 2017;12(2):156-168.