Chest Tube Ascariasis An Extremely Rare And Bizarre Presentation Of Colopleural Fistula With Traumatic Diaphragmatic Hernia : A Case Report And Review Of Literature

摘要

A highly unusual and interesting case of Ascaris worms emerging through an intercostalchest tube is reported here because of its association with presence of colo-pleural fistula associated with left post traumatic diaphragmatic hernia detected subsequently. Review of the literature revealed only one reported case of chest tube ascariasis not associated with colopleural fistula1 and only five reported cases6-11 of colopleural fistula associated with diaphragmatic herniation, but none associated with pleural ascariasis. The combination of chest tube (pleural) ascariasis, colopleural fistula and left traumatic diaphragmatic hernia makes this case an extremely rare and bizarre presentation, probably only reported case of its kind and truly worthy for publication. Case Report A 24-year-old woman, was admitted in the Emergency Department, complaining of left-sided chest pain and dry cough on and off for six months. Two day prior to admission, she had developed sudden-onset, sharp and progressively increasing in severity left-sided chest pain radiating to the back, aggravated by breathing, with no relieving factors. This pain was associated with dry cough and difficult breathing.Her blood investigations revealed moderate anemia (hemoglobin 7.5 gm/dl), mild leucocytosis with eosinophilia ( Total WBC count 14000/mm3, Absolute eosinophilic count 650/mm3). Her chest X-ray revealed moderate left pleural effusion.Based on clinical and X-ray findings a chest tube was inserted, which drained a feculent odor dirty fluid. Around 24 hrs subsequent to chest tube insertion two adult ascaris worm were noted emerging from the chest tube and collecting in the drainage bag. (Fig 1)