International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 06 Issue 22, November, 2014

Pages: 22-24

Date of Publication: 21-Nov-2014


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AN EXTREMELY RARE REPORT OF FINDING MULTIPLE HOOKWORMS IN THE JEJUNAL PART OF GASTROJEJUNOSTOMY STOMA INSTEAD OF ITS USUAL SITE IN DUODENUM WHILE DOING UPPER GASTRO INTESTINAL ENDOSCOPY

Author: Govindarajalu Ganesan

Category: Healthcare

Abstract:While doing upper gastro intestinal endoscopy hookworms are most commonly found in duodenum and very rarely in stomach. But interestingly multiple hookworms were seen in the jejunal part of gastrojejunostomy stoma while doing upper gastro intestinal endoscopy in a 45 year old female patient who had undergone Truncal Vagotomy and gastrojejunostomy. Such endoscopic finding has not been reported so far. The patient underwent upper gastro intestinal endoscopy since she had dyspepsia for the last few months. But infection with multiple hookworms was found to be the cause of her dyspepsia after endoscopy. Hence upper gastro intestinal endoscopy is a very useful investigation to diagnose hookworm infection of duodenum, stomach and even the jejunal part of gastrojejunostomy stoma.

Keywords: Hookworm, Upper gastro intestinal endoscopy, Jejunal part of gastrojejunostomy stoma

Full Text:

INTRODUCTION
There has been many reports of finding hookworms in duodenum while doing upper gastro intestinal endoscopy (1to10). Rarely hookworm is also reported to occur in stomach while doing upper gastro intestinal endoscopy (10to13). But there has been no reports of finding hookworms in the jejunal part of gastrojejunostomy stoma while doing upper gastro intestinal endoscopy. Hence an extremely rare report of finding multiple hookworms in the jejunal part of gastrojejunostomy stoma while doing upper gastro intestinal endoscopy is given here.

CASE REPORT
A 45 year old female patient who had undergone Truncal Vagotomy and gastrojejunostomy before six years and having dyspepsia for the last few months was subjected to upper gastro intestinal endoscopy. But very interestingly multiple hookworms were found actively moving in the jejunal part of gastrojejunostomy stoma (Fig 1,2). The head and the mouth of the hookworm is bent backward dorsally like a hook (Fig3) giving the name hookworm to it. It is S-shaped due to its dorsal bend at the head end (Fig3,4). Locomotion is by longitudinal muscles on one side contracting, while the other side expands, deforming the body into S-shaped curves (Fig 2,3,4). Two hookworms lying extremely close to one another (Fig 1) were retrieved out using biopsy forceps and immediately sent for microbiological examiniation. By microbilogical examiniation the two hookworms were identified as male and female hookworms and were also identified as Ancylostoma duodenale. The patient was treated with a single dose of 400mg of albendazole and her symptoms resolved.

DISCUSSION There are two human-specific hookworms, namely Ancylostoma duodenale and Necator americanus (4). Usually, the diagnosis of hookworm infection is made by the characteristic egg shape appearance on faecal examination (4). However, misdiagnosis is due to the absence of eggs of the parasites in stools (4). In such situation upper gastro intestinal endoscopy becomes an extremely useful investigation to diagnose hookworm infection (4). Hookworm is an elongated, unsegmented round worm belonging to the the Phylum Nematoda. When a round worm is found during upper gastrointestinal endoscopy, differential diagnosis is important to determine the diagnosis for the appropriate treatment (4). This can be achieved according to the morphology of the worms under microscopy and their location in the gastro intestinal tract (4). The common intestinal worms include Ascaris lumbricoides, Trichuris trichiura (whipworm), Enterobius vermicularis (pinworm), Strongyloides stercoralis and Anisakis simplex in addition to hookworms (Ancylostoma duodenale and Necator americanus) (4). Ascaris is a large roundworm (15-40cm in length) and inhabits the small intestine (4). Whipworm is 30-50mm in length and inhabits the large intestine (especially around caecum ) (4). Pinworm (10mm in length) also inhabits the same areas as the whipworm (4). Therefore, both the parasites are very rarely observed during upper gastrointestinal endoscopy (4). Strongyloides stercoralis inhabits the mucosa of duodenum or upper jejunum and is pretty small (2-3 mm in length) and relatively rare (4). The larva of anisakis simplex is found usually in the stomach of human beings and measures 2cm in length. Hookworms usually reside in the upper portion of the small intestine (4). In our study also multiple hookworms were found in the jejunal part of gastrojejunostomy stoma. Hence in our study also, hookworms were found to reside in the upper portion of the small intestine. Hookworm is identified by its characteristic bent head giving it a hook like appearance (Fig3,4). Hookworm is also Sshaped due to its bend at the head end (Fig3,4). Locomotion is by longitudinal muscles on one side contracting, while the other side expands, deforming the body into Sshaped curves (Fig 2,3,4). By all these features the round worm seen in this patient was identified as hook worm. The worms were also retrieved out using biopsy forceps and by microscopic examiniation were also confirmed as Ancylostoma duodenale. This patient presented with dyspepsia and upper gastro intestinal endoscopy was carried out in this patient due to her dyspepsia. But infection with multiple hookworms was found to be the cause of her dyspepsia after upper gastro intestinal endoscopy. Thus hookworm infection can present with dyspepsia and upper gastro intestinal endoscopy is a very useful investigation to diagnose hookworm infection.

CONCLUSION
Hence upper gastro intestinal endoscopy is very useful to diagnose the presence of hookworms in duodenum, stomach and even in the jejunal part of gastrojejunostomy stoma. Hence upper gastro intestinal endoscopy is a very useful investigation to diagnose hookworm infection of the entire gastro intestinal tract.

ACKNOWLEDGEMENT
The author sincerely thanks G. Kumaresan, computer engineer, for his immense help in labeling the figures of this article. The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The author is extremely grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.

References:

1. Hyun HJ, Kim EM, Park SY, Jung JO, Chai JY, Hong ST . A case of severe anemia by Necator americanus infection in Korea. J Korean Med Sci. 2010 Dec;25(12):1802-4.

2. Kato T, Kamoi R, Iida M, Kihara T.Endoscopic diagnosis of hookworm disease of the duodenum J Clin Gastroenterol. 1997 Mar;24(2):100-102

3. Kibiki GS, Thielman NM, Maro VP, Sam NE, Dolmans WM, Crump JA. Hookworm infection of the duodenum associated with dyspepsia and diagnosed by oesophagoduodenoscopy: case report. East Afr Med J. 2006 Dec;83(12):689- 92.

4. Wu KL, Chuah SK, Hsu CC, Chiu KW, Chiu YC, Changchien CS. Endoscopic Diagnosis of Hookworm Disease of the Duodenum: A Case Report. J Intern Med Taiwan 2002;13:27- 30.

5. Kuo YC, Chang CW, Chen CJ, Wang TE, Chang WH, Shih SC . Endoscopic Diagnosis of Hookworm Infection That Caused Anemia in an Elderly Person. International Journal of Gerontology. 2010 ; 4(4) : 199-201

6. Zaher, T. I., Emara, M. H., Darweish, E., Abdul-Fattah, M., Bihery, A. S., Refaey, M. M., and Radwan, M. I. Detection of Parasites During Upper Gastrointestinal Endoscopic Procedures. Afro-Egypt J Infect Endem Dis 2012; 2 (2): 62-68.

7. Mahadeva S, Qua C-S, Yusoff W, et al. Repeat endoscopy for recurrent iron deficiency anemia: an (un)expected finding from Southeast Asia. Dig Dis Sci 2007;52:523–525

8. Reddy SC, Vega KJ. Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointest Endosc May 2008;67(6) 990-992

9. Nakagawa Y, Nagai T, Okawara H, Nakashima H, Tasaki T,Soma W, et al. Comparison of magnified endoscopic images of Ancylostoma duodenale (hookworm) and Anisakis simplex.Endoscopy 2009;41(Suppl. 2):E189

10. LEE, T.-H., YANG, J.-c., LIN, J.-T., LU, S.-C. and WANG, T.- H. Hookworm Infection Diagnosed by Upper Gastrointestinal Endoscopy: —Report of Two Cases with Review of the Literature—. Digestive Endoscopy, 1994 6(1): 66–72

11. Thomas V, Jose T, Harish K, Kumar S. Hookworm infestation of antrum of stomach. Indian J Gastroenterol 2006 May-Jun;25(3):154

12. Dumont A, Seferian V, Barbier P.Endoscopic discovery and capture of Necator Americanus in the stomach. Endoscopy. 1983 Mar;15(2):65-6.

13. Rana SS, Bhasin DK, Sinha SK ). Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointestinal endoscopy, 2008 Nov; 68(5), 1023.

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A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
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A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
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A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
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A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
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A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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