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Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis a case report.doc

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Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis a case report

Cruzetal.WorldJournalofEmergencySurgery2010,5:23 /content/5/1/23 WORLD JOURNAL OF EMERGENCY SURGERY CASE REPORT OpenAccess Duodenalobstruction-anunusualpresentation ofStrongyloidesstercoralisenteritis:acasereport RuyJCruzJr ,RodrigoVincenzi ,BernardoMKetzer2 1* 2 Abstract Background:Intestinalobstructionisapoorlyrecognizedandprobablyunderreportedcomplicationof strongyloidiasis.Wepresenthereinanunusualcase,ofcompleteduodenalobstructioncausedbyS.stercoralis. Methods:Asystematicreviewoftheliteratureexaminingtheclinicalcourse,diagnosticmethods,andoutcomeof thisrarecomplicationofstrongyloidiasiswasperformed. Results:A42-year-oldwomanpresentedwitha5-monthhistoryofabdominalpain,vomit,andweightloss.An abdominalCTscanshowedanobstructionofthethirdpartoftheduodenum.Segmentalintestinalresectionwas carriedoutandhistopathologyexaminationrevealedheavyStrongyloidesstercoralisinfestation.Duodenal obstructionisararecomplicationofS.stercoralisinfection,withonly8casesdescribedintheliteraturesince1970. Mostofthepatientsaremales,middle-aged,andthediagnosiswasmadebyduodenalaspirate/biopsy,oranalysis ofsurgicalspecimen. Conclusions:Duodenalobstructionisanunusual,butpotentialfatal,complicationofS.stercoralisinfection.The largespectrumofclinicalmanifestationandlackofclassicclinicalsyndromemakethefinaldiagnosisof strongyloidiasisextremelydifficult.Ahighindexofsuspicion,mainlyinpatientsfromendemicareas,isneededfor correctandearlydiagnosisofthisuncommonpresentationofStrogyloidesstercoralisenteritis. Background performedasystematicreviewoftheliteratureexamin- Strongyloidiasisisaparasiticdisease,causedbyanema- ingtheclinicalcourse,diagnosticmethods,management todehelminth,Strongyloidesstercoralis.Thetruepreva- and outcome of this rare, but potential fatal complica- lence of S. stercoralis is likely underestimated because tionofS.stercoralisinfection. infection is often subclinical [1-3]. Currently, an esti- mated 100 million people are infected worldwide in Methods more than 70 co