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Incidental detection of Ascaris lumbricoides by wireless capsule endoscopy.

To the Editor: Wireless capsule endoscopy (WCE) is an important procedure to evaluate patients with obscure gastrointestinal bleeding, chronic abdominal pain, chronic diarrhea, suspected Crohn disease, celiac disease, and iron deficiency anemia. The incidental findings of WCE are often diagnostic and may permit us to expand our indications for this procedure. In this letter we report a case of an incidental detection of Ascaris lumbricoides by WCE. A 72-year-old Honduran women presented to our care with a history of left upper quadrant abdominal pain for 5 years. She had undergone previous diagnostic tests that included abdominal ultrasound, computed tomograph of the abdomen, esophagogastroduodenoscopy, and a colonoscopy that did not reveal any pathology. WCE was performed to evaluate the etiology for the abdominal pain. The study revealed images seen in Figure 1, and are consistent with Ascaris lumbricoides infection. The patient was started on tinidazole100mg twice a day for 3 days. Three days after taking the medication the patient had stool analysis performed. The stool was negative for ova and parasites. On follow-up, she stated that the abdominal pain resolved with the medication. Suspected roundworm infection is not an indication to perform WCE, nor is it cost-effective. Formalin concentration technique of the stool is the most cost effective way to examine for ova and parasites. In our patient, WCE was performed to evaluate the etiology of her left upper quadrant abdominal pain. The finding of roundworms was incidental. Ascaris lumbricoides, an intestinal roundworm, is one of the most common helminthic human infections. Individuals with a high worm load can develop pulmonary, intestinal, pancreatic, or hepatobilary symptoms. WCE has become a powerful tool to identify pathology in the small bowel when other diagnostic measures have been unyielding. Occasionally, unexpected findings are discovered on WCE that help in management of the patient. In addition, it is important to consider common diseases of the developing world in the differential diagnosis of abdominal pain.