Presentation
Subacute nausea, diarrhea, and non-specific abdominal pain.
Patient Data
Oral and IV enhanced abdomen and pelvis CT scan that shows a central linear filling defect in the jejunum. If tracked, the structure is continous/solitary.
There is no bowel obstruction.
When projecting en-face, the anomaly resembles a "target sign".
Case Discussion
The diagnosis is intestinal ascariasis.
Ascariasis is one of the most common parasitic infections in humans. It is transmitted via the fecal-oral route. Although infected individuals are usually asymptomatic, it results in considerable morbidity and mortality given its high prevalence. Some patients develop non-specific abdominal symptoms.
The presence of intestinal linear filling defects is highly suggestive of a helminthic infestation.
Potential complications include mechanical bowel obstruction if the disease burden is high; biliary or pancreatic ducts obstruction by migrated worms and resultant obstructive complications (e.g. pancreatitis, biliary colic, etc); and in case the worms perforate through the bowel wall and migrate into the pulmonary circulation, ascaris pneumonia and Loeffler syndrome may occur.
Definitive diagnosis requires identification of Ascaris eggs and/or worms on stool analysis.
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