STORY OF ROUND WORMS

Nina came to our hospital in June1960; I was a bit more experienced as a doctor. It had been just over a year since I graduated. She complained of a lump on the lower left side of her abdomen, with frequent abdominal pain. She was a young girl of about 20 years of age and not married. She was nonvegetarian. She looked under nourished. She had not had a menstrual period for six months her blood count showed, what we call mild eisinophilia, we did not pay much attention to this , although Ascaris can cause an eisinophilic pneumonitis. This can happen even without Ascaris her ESR was raised. Surprisingly the stool examination did not show any Ascaris ova this means that she had an infection somewhere.  Genital Tuberculosis was fairly common in India in those days. This can cause pelvic mass and absent periods. We had very basic x-ray services and ultrasound was unknown in the sixties. A clinical diagnosis of pelvic tuberculosis was entertained. She was given Anti tubercular treatment for three months but nothing changed. It was decided to do a laparatomy: guess what we found. A lump made of 16 Ascaris worms totally sealed by the peritoneum, arising from the fallopian tubes. There were sixteen worms in all. They were all removed. No holes could be seen in the bowel. The abdominal cavity was cleaned and closed. Nina made an uneventful recovery. She was subsequently given more treatment to clean her bowel of any Ascaris. It was also explained to her about personal hygiene and the meat she consumed. The cause of her not having a period was probably due to her poor nutrition. Her chest x-ray was clear 

Ascaris is one of the most common worm infections in the world. About one billion people suffer from it. It is a big fat round worm,

which can grow up to 35 cmin length. It can go round different parts of the body via the blood stream. Initially it can cause eisinophilia in the blood which we ignored, as there were no Ascaris ova in the stool.  In gynaecological literature many cases of Ascaris in the fallopian tubes have been described, and the first one was in 1926.