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    Ascariasis is the most common helminthic infection, with an estimated worldwide prevalence of 25% (>1.25 billion people). Usually asymptomatic, infections are most prevalent in tropical and developing countries, where they are perpetuated by contamination of soil by human feces or use of untreated feces as fertilizer. Symptomatic disease may be manifested by growth retardation, pneumonitis, intestinal obstruction, or hepatobiliary and pancreatic injury. In developing countries, ascariasis may exist as a zoonotic infection associated with exposure to pigs or pig manure.

    Intestinal obstruction in children is the most commonly attributed fatal complication, resulting in 8000-100,000 deaths per year, according to the World Health Organization. Besides direct obstruction of the bowel lumen, toxins released by live or degenerating worms may result in bowel inflammation, ischemia, and fibrosis.


    Symptoms include cough, dyspnea, asthma, and chest pain (during the initial lung migration). This may be seasonal in some countries, such as Saudi Arabia.

    Abdominal pain, distension, colic, nausea, anorexia, and intermittent diarrhea may be manifestations of partial or complete intestinal obstruction by adult worms.

    Jaundice, nausea, vomiting, fever, and severe or radiating abdominal pain may suggest cholangitis, pancreatitis, or appendicitis.


    Rales, wheezes, and tachypnea may be present during pulmonary migration.

    Abdominal distension is nonspecific but is often observed in children with worms.

    Abdominal tenderness, especially in the right upper quadrant, hypogastrium, or right lower quadrant, may suggest complications of ascariasis.

    January 7, 2007

  • An omphalocele is a type of abdominal wall defect in which the intestines, liver, and occasionally other organs remain outside of the abdomen in a sac because of a defect in the development of the muscles of the abdominal wall. The sac protrudes in the midline, through the umbilicus (navel).

    It is normal for the intestines to protrude from the abdomen, into the umbilical cord, until about the tenth week of pregnancy, after which they return to inside the fetal abdomen.

    The omphalocele can be mild, with only a small loop of intestines present outside the abdomen, or severe, containing most of the abdominal organs. In severe cases surgical treatment is made more difficult because the infant's abdomen is abnormally small because it had no need to expand to accommodate the developing organs.

    An omphalocele is often detected through AFP screening or a detailed fetal ultrasound. Genetic counseling and genetic testing such as amniocentesis is usually offered during the pregnancy. Some cases of omphalocele are due to an underlying genetic disorder.

    January 7, 2007


    Gastroschisis is an abnormality (defect or hole) in the abdominal wall that allows the abdominal contents to protrude outside the body. There is no peritomeal covering over the bowel or other contents. The defect is located to the right of the umbilicus (belly button/navel) and is completely separate from the umbilicus. The abnormality is usually very small, but the exposed contents can range from the stomach to the rectum (almost all of large and small bowel can become exposed). The stomach may be involved but not the liver.

    Gastroschisis has no sac covering the exposed contents.

    It occurs in the first born 74% of the time.

    The malformation is always obvious at birth and able to be seen as early as 14 weeks of pregnancy

    The associated problems are :

    Prematurity (55%)

    Intra uterine growth retardation (77%)

    Cardiac problems

    Minor malformations in small bowel, may be a part of the Gastroschisis itself

    Intestine shortened to as much as one third of the normal length.

    In Gastroschisis, the bowel is not contained, but floats freely with the amniotic fluid. Contact with amniotic fluid may cause severe damage to the bowel, which suffers growth failure, becoming thickened, matted, shortened and with poor mucosal function. This damage become more severe with prolonged exposure to amniotic fluid, and accelerates from thirty-five weeks gestation.

    January 7, 2007

  • Approximately 0.5% of routine chest radiographs reveal an azygos lobe. This normal variant consists of the upper right lung developing around the azygos vein. The vein remains in the substance of the lungs but as the upper lobe develops inferiorly to superiorly, a double fold of visceral pleura (two layers of visceral pleura and two layers of parietal pleura) develops. This invagination can be identified on a chest x-ray. The classic finding on a chest film created by the double pleural fold is the “reverse comma sign�? that extends towards the top of the right lung in a curvilinear fashion ending at the apex of the parietal pleura. The base of the comma is formed by the vein itself. It is important to remember that the azygos lobe is not a true lobe with a separate segmental bronchus. However, this lobe can be involved independent of the other lobes of the lung with disease such as cancer, tuberculosis, or pulmonary metastasis.

    January 6, 2007

  • A normal variant produced by an indentation in the R. upper lobe of the lung by four layers of pleura (two layers of visceral pleura and two layers of parietal pleura). It is produced by invagination of the azygous vein. This is not a true lobe, since it does not have a separate bronchus.

    January 6, 2007

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