Strongyloidiasis surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Strongyloidiasis is usually managed with medical therapy, but surgery is indicated when medical management fails or complications arise.^[1]

Some of the indications for the surgical management of strongyloidiasis include:

• Complete intestinal obstruction with inadequate decompression
• Lack of response within 24-48 hrs of medical management of obstruction
• Complications such as volvulus, intussusception, or intestinal perforation
• Acute appendicitis
• Worms trapped in ducts
• Liver invasion by worms

Intestinal obstruction due to strongyloidiasis should be managed conservatively by:

• Nasogastric decompression
• Fluid and electrolyte repletion
• Antihelminthic therapy once bowel motility is restored. Piperazine causes flaccid paralysis of the worms, which can help relieve the obstruction through rapid expulsion of the worms
• Complete obstruction with inadequate decompression, lack of response within an interval of 24-48 hrs, volvulus, intussusception, or perforation should be managed surgically

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