Retroperitoneal Ascariasis: A Case Report

Abstract

Infection with adult Ascaris primarily occurs in the gastrointestinal system, but physical migration other than this has been reported. To date, only a small number of cases have been reported to involve the urinary system and no report of Ascariasis migration to the retroperitoneal space.

This is a case of a 38-year-old female admitted as a case of perinephric abscess, renal mass right. Patient was initially managed conservatively with broad spectrum antibiotics and tube drainage, but with the deteriorating condition, an exploratory laparotomy, with retroperitoneal exploration was done. During exploration, no colonic fistula was noted. The renal parenchyma was noted to be pinkish with a 1cm opening at the mid lateral pole associated with purulent discharge. Interestingly, a 6cm x 1cm wax-like, moving structure was found in the retroperitoneal space The object was removed with Debakey forceps and was determined to be Ascaris lumbricoides by histopathology. Fecal analysis of stool for ova and parasites was negative for Ascaris. The patient then had an uneventful recovery.

Currently, there are only two theories on how Ascaris lumbricoides can be introduced into the urinary system. The first includes fistulation between the GI and urinary system and second by retrograde migration of the adult worm through the urethra. Given the current data, the authors believe that the patient experienced retrograde invasion of Ascaris through the urethra, and subsequently migrated to the retroperitoneal space through fistulation.

Ascariasis of the genitourinary tract is a rare condition. This is the first reported case of ascariasis in the retroperitoneum.