Strongyloidiasis surgery

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

## Overview

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

## Surgery

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### Indications

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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

### Management of intestinal obstruction

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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

## References

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1. ↑ Segarra-Newnham M (2007). "Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection". Ann Pharmacother. 41 (12): 1992–2001. doi:10.1345/aph.1K302. PMID 17940124.

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