Do roundworms in the gut cause clinical problems?

Many children with roundworms appear healthy and have no symptoms. Often the only way the parents know that their children have roundworms, is when worms are seen in the stool. Sometimes worms can be vomited. When the child is ill with a fever, roundworms may make their way up the child’s oesophagus and come out of the nose.

Large numbers of worms in the bowel can cause problems:

  • Vague abdominal pain or discomfort
  • The amount of food they use can contribute to malnutrition (undernutrition). Roundworms also decrease the child’s appetite.
  • A large bunch (bolus) of worms can cause colic (cramping abdominal pain) and even total small bowel obstruction. The mass of worms may be palpable on abdominal examination.
  • Migrating worms can get stuck in the bile duct, resulting in acute, severe pain over the liver (biliary colic).

Roundworms can also cause bowel perforation, volvulus, intussusception, colangitis and pancreatic duct obstruction. With heavy infections, bunches of roundworms can be seen in a plain abdominal X-ray. Do not give mebendazole or albendazole if acute abdominal pain is present as treatment increases the worms’ tendency to migrate and may precipitate bowel obstruction. Surgery must be considered if there are signs of obstruction.

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