When a tiny wireless camera was inserted inside the small intestines of a 14-year-old boy from Haldwani, doctors could see two distinct images. The first half of the intestines appeared normal. But the second half had turned blood red.
A deeper examination showed hookworms which had, over the last two years, silently sucked at least 22 litres of blood from the boy, doctors at Sir Ganga Ram Hospital said. On an average, a 14-year-old has a blood volume of four litres in his body.
Doctors had, for a long time, suspected that the boy was suffering from anaemia. But with medication not having the desired effect, doctors conducted a capsule endoscopy, during which they found dancing worms buried in the mucosa of the small bowel, actively sucking blood.
While hookworm infection is common in the country, doctors say this case is unique because the problem went undiagnosed for two years. Instead, doctors kept treating the boy for anaemia, and he received 50 units of blood.
“Hookworm is a common problem in India and can be prevented by not walking barefoot and maintaining food hygiene. It resides in the small intestines and causes chronic anaemia. But in this case, while the boy had low haemoglobin of 5.86, there was no associated pain in the abdomen, fever, and diarrhoea. The boy had constant loss of blood. And the doctors had repeatedly conducted endoscopy of the foodpipe, colonoscopy and radiographic contrast studies of intestines — which were reported to be normal. For two years, doctors could not diagnose that hookworms in the small intestines were the reason behind the blood loss,” Dr Anil Arora , chairperson of the department of gastroenterology at Sir Ganga Ram Hospital, told The Indian Express.
“In view of the child’s obscure gastrointestinal bleeding, we conducted a capsule endoscopy, where a tiny wireless camera is inserted into your digestive tract. The results shocked us. We could see multiple hookworms buried in the small intestines, actively sucking blood with dancing movement. The blood could be seen in the cavity of the hookworms, giving them a red colour. White coloured hookworms, which had not yet sucked blood, were seen lying quietly in the small bowel,” Dr Arora said.
Dr Arora said the case highlights the need to examine the small intestines in case of heavy blood loss. “It was a case of unexplained blood loss. Normally, when there is bleeding, we do an endoscopy of the stomach or perform a colonoscopy to look at the rectum. The small intestine, which is between the large intestine and stomach, is totally ignored. This case shows how important examination of the small intestine is,” Dr Arora said.