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Pediatric Ascariasis Treatment & Management

  • Author: William H Shoff, MD, DTM&H; Chief Editor: Russell W Steele, MD  more...
Updated: Jan 05, 2015

Medical Care

Pulmonary disease

Most cases are asymptomatic.

Most symptomatic cases are mild and self-limited (days) and do not require therapy.

Bronchospasm can be managed with conventional therapy.

Severe cases can be managed with systemic steroids and oxygen supplementation.

Partial small bowel obstruction

In the absence of signs of toxicity (eg, fever, tachycardia, protracted vomiting, peritoneal signs), persisting abdominal pain, or a palpable mass in the same site for more than 24 hours, several conservative management strategies, including supportive care, have proven efficacious. Some of these strategies are as follows:

Intravenous fluids and nasogastric tube with or without an antispasmodic (antimuscarinic)

Intravenous fluids, nasogastric tube, and antibiotics (eg, metronidazole, aminoglycoside, penicillin) with or without an antihelminthic after resolution of symptoms

Saline enema with or without an antispasmodic: Saline enemas are effective in children because 80% have an incompetent ileal-cecal sphincter.

Racine or mineral oil (15-30 mL via nasogastric tube) in conjunction with an antihelminthic: A low dose is used to allow worm death over few days. Several reports note that administration of antihelminthics in patients with partial bowel obstruction can precipitate complete obstruction.

Gastrografin (15-30 mL) via nasogastric tube: The hyperosmolar action results in increased fluid around worms, which favors their separation.

In the presence bowel obstruction, persisting or worsening abdominal pain, or sepsis, surgical intervention is warranted (see Surgical Care).

Hepatobiliary and pancreatic ascariasis

This typically manifests as biliary colic, acalculous cholecystitis, ascending cholangitis, pancreatitis, or hepatic abscess. Ascariasis is a common cause of these conditions in endemic countries.

Aggressive antibiotic therapy for suspected infection and early ERCP to remove the worms are highly efficacious together in the treatment of HPA. During ERCP, worms are sometimes observed to be moving into and out of the duct orifices. Worms are directly removed; when they are out of reach, they can be flushed out with rapid injection of 5-10 mL of diluted dye (eg, 10% Urograffin) into the duct. The entire worm must be removed because fragments lead to infection, granulomas, or stone formation.

After abdominal symptoms improve, antihelminthics can be administered. In one series, the ERCP complication (cholangitis, hypotension) rate was 6%.[14]


Surgical Care

In endemic regions, ascariasis is a major etiology for conditions that require acute surgical intervention, including the following:

  • Intestinal obstruction
  • Appendicitis
  • Volvulus
  • Intussusception
  • Ischemic bowel
  • Hepatobiliary obstruction (if ERCP has failed or is unavailable)
  • Failure of conservative management of partial bowel obstruction
  • Severe abdominal pain or tenderness with signs of toxicity
  • Persisting or worsening abdominal pain
  • Severe abdominal pain with a palpable mass in the same site for longer than 24 hours

Surgical procedures used in the management of the bowel obstruction secondary to ascariasis include the following:

Milking the worms through the ileo-cecal valve: This is recommended for a worm bolus in the distal ileum. Milking proximal boluses may cause damage to the bowel. This process has been facilitated by oral administration of mineral oil (15-30 mL).

Enterotomy to remove the bolus if milking is unsuccessful

Segmental resection of damaged bowel with or without temporary ostomy, as needed: Anastomosis should be 2-layers and end-to-end to prevent residual worms from migrating through the anastomosis into the peritoneal cavity, which has been reported.




Any patient with acute abdominal pain and tenderness suggestive of an acute surgical process warrants a surgical consultation. If a double-contrast (ie, oral and intravenous dye) CT scan can be performed and the patient is not toxic or septic, the consultation may be deferred until the results of the scan are available. If the patient is toxic or septic, the surgical consultation should take place immediately.

Critical care specialist

Any patient who appears to be septic may qualify for early goal-directed therapy.

GI specialist

Any patient who is diagnosed with HPA or in whom a high index of suspicion for this diagnosis is noted warrants an immediate GI consultation for emergent ERCP. This procedure is often both diagnostic and therapeutic, with removal of the offending worm and relief of the obstruction.



Advise patients with known ascariasis to avoid peppery and spicy foods because they induce increased worm migration.

Contributor Information and Disclosures

William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.


Catherine T Shoff, DO Staff Physician, Departments of Pulmonary, Critical Care and Sleep Medicine, Director, Tri-Services Adult Cystic Fibrosis Center, Wilford Hall Medical Center; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Catherine T Shoff, DO is a member of the following medical societies: American College of Chest Physicians, American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Michael D Nissen, MBBS FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists of Australasia, Royal Australasian College of Physicians, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.


Michael E Greenberg, MD, MPH Clinical Instructor, Department of Pediatrics, University of California at San Francisco

Michael E Greenberg, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, and American Public Health Association

Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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The roundworm Ascaris lumbricoides causes ascariasis. Worms can reach 10-30 cm in length. Clinical disease results from effects of pulmonary larval migration, intestinal obstruction, or migration through the biliary tree.
Table 1. Major Soil-Transmitted Helminths [1, 2]
Parasite* Disease Prevalence
A lumbricoides Common roundworm infection, ascariasis 800 million to 1.4 billion
T trichiura Whipworm infection, trichuriasis 600 million to 1 billion
Necator americanus and

Ancylostoma duodenale

Hookworm infection 580 million to 1.2 billion
Strongyloides stercoralis Threadworm infection, strongyloidiasis 30-300 million
Enterobius vermicularis Pinworm infection 4-28% of children
Toxocara canis and

Toxocara cati

Visceral larva migrans and ocular larva migrans 2-80% of children
*All major parasites are found in tropical, subtropical, and temperate climates.
Table 2. Minor Soil-Transmitted Helminths [1, 2]
Minor Parasite Disease Distribution
Ancylostoma braziliense Cutaneous larva migrans Costal regions worldwide
Uncinaria stenocephala Cutaneous larva migrans Costal regions worldwide
Ancyclostoma canium Eosinophilic enteritis Australia
Ancylostoma ceylanicum Hookworm infection Asia
Oesophagostomum bifurcum Nodular worm infection North America
Strongyloides fuelleborni Swollen belly syndrome West Africa
Ternidens diminutus False hookworm infection Southern Africa
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