An Unusual Cause of Partial Small Bowel Obstruction in a Young Male With HTLV-1

Abstract

Introduction: There are several causes of small bowel obstruction; in developed countries, these include adhesions, malignancy, and Crohn’s disease. Here, we present an unusual etiology of partial small bowel obstruction and weight loss in a young male. A 45-year-old male who had emigrated from Ghana presented with one year of post-prandial nausea, vomiting, associated 50-pound weight loss, and a diffusely tender abdomen. Laboratory tests revealed 6% eosinophils without leukocytosis and positive HTLV-1 antibodies. Abdominal x-ray revealed a 3.5-cm dilated jejunum in the upper abdomen and multiple air-fluid levels, suggestive of partial proximal small bowel obstruction. The patient was treated with conservative management with IV fluids and nasogastric tube drainage. Given his history of persistent nausea, vomiting, and weight loss, an EGD was performed, which revealed inflammation of the antral and duodenal mucosa with some ulcerations. Gastric and duodenal biopsy results were positive for Strongyloides stercoralis (Figure 1). A diagnosis of S. stercoralis infection with partial small bowel obstruction was established. He was treated with albendazole 400 mg twice daily for 3 days and Ivermectin 200 mcg/kg daily for a total of 6 weeks. The patient was relieved of his symptoms and was noted to gain weight with conservative management. Strongyloides stercoralis is a nematode that burrows in the mucosa of the small intestine. Duodenal obstruction is a rare complication of strongyloidiasis, with only few cases reported in the medical literature. It can occur in severe infection with the parasite due to mucosal edema and inflammation. Widespread strongyloidiasis can also cause paralytic ileus. HTLV-1 affects cell-mediated immunity and increases the risk of severe infection. Parenteral therapy is not available for strongyloidiasis, which makes conservative management of duodenal obstruction and paralytic ileus in this setting challenging. Although surgical management of duodenal obstruction has been reported in the literature, if an early diagnosis is made, then conservative treatment may be used with favorable outcomes, as seen in this patient.Figure 1: Duodenal biopsy.