Jejunojejunal Intussusception by Ascaris lumbricoides - A Case Report

Adult intussusception is a rare clinical entity, accounting for a small fraction of bowel obstructions, with the vast majority of cases driven by underlying structural lesions, neoplasms, or malignancies [1]. Consequently, jejunojejunal intussusception caused by an Ascaris lumbricoides infestation is exceptionally rare, particularly in non-endemic and developed settings where such soil-transmitted helminthiases are highly unusual [2,3]. A 69-year-old white male from a rural area, with no significant medical history, presented in the emergency department with acute abdominal pain and vomiting with a few hours of evolution, notably lacking fever, B symptoms, or diarrhea. Physical examination showed only mild epigastric discomfort and initial work-up at admission revealed only an elevation of C-reactive protein (4 mg/dL). Complete blood count was unremarkable and celiac serology was negative with normal imunoglobulin A levels. An infectious work-up, including stool culture, was negative, though a stool test for parasites was not conducted. A computed tomography (CT) was performed and showed a jejunojejunal intussusception and the patient was admitted for etiological study and treatment. Management commenced with bowel rest and intravenous fluids, alongside the placement of a nasogastric tube, which was subsequently removed after yielding no drainage. The patient eventually started enteral nutrition after 48 hours with good tolerance, maintaining regular bowel movements throughout his hospitalization. A follow-up CT enterography showed no abnormalities, and symptoms resolved spontaneously, allowing discharge after a few days. To exclude an underlying structural lead point, both abdominal ultrasonography and capsule endoscopy were requested for outpatient follow-up. Abdominal ultrasound revealed multiple mobile linear and tubular structures within the jejunal lumen, up to 35 mm long, with hyperechoic walls and hypoechoic centers, exhibiting classic "train-track" or "target" signs suggestive of adult Ascaris lumbricoides worms. No biliary or pancreatic involvement was noted. Capsule endoscopy confirmed numerous elongated, serpiginous, mobile parasites in the jejunum, distorting mucosal folds and likely causing the intussusception. The patient received a single dose of oral albendazole 400 mg, resulting in parasite expulsion and complete resolution of intussusception on follow-up imaging. Post-treatment parasite stool tests were negative. After two years of follow-up, he remained completely asymptomatic. This case demonstrates that transient intussusception can be secondary to the dynamic motility of Ascaris lumbricoides. Spontaneous resolution permitted a conservative approach, sparing the patient from an unnecessary surgery. Furthermore, it emphasizes the synergy of multimodal imaging: although CT identified the anatomical obstruction, real-time ultrasonography and capsule endoscopy were essential to establish the etiological diagnosis non-invasively. Ultimately, this rare case highlights the remarkable pathognomonic images captured and the value of both capsule endoscopy and abdominal ultrasound in identifying real-time visualization of Ascaris lumbricoides intraluminal motility as an uncommon etiology of adult intussusception.