Images in Clinical Medicine

Kim Eagle, M.D., Editor

Ascaris lumbricoides

Hermann Fuessl, M.D.

N Engl J Med 1994; 331:303August 4, 1994

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Article

Figure 1 Ascaris lumbricoides.

Upper endoscopy was performed in a 19-year-old man from Afghanistan because of four days of watery diarrhea and dysphagia without abdominal pain. Stool examination revealed no parasitic ova, and cultures were negative for bacterial pathogens. Endoscopy revealed an erosive inflammation of the terminal esophagus. In the duodenum, two worms (Panel A and Panel B) were removed with biopsy forceps -- one a female (length, 28 cm) and the other a male (length, 18 cm) Ascaris lumbricoides. Both worms are shown after removal (Panel C). After treatment with mebendazole, the patient passed several worms in the feces. It is unusual to diagnose ascariasis during upper endoscopy, because the worms live in lower parts of the small intestine, but they may migrate and can enter the common bile duct and cause obstruction.

Kim Eagle, M.D.

Hermann Fuessl, M.D.
Munich University, 80336 Munich, Germany