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To the Editor.—
The article by de la Riva et al, entitled "Acute Massive Intestinal Bleeding Caused by Hookworm" (1981;246:68), called to mind the presentation that I made to the joint meeting of the Argentine and Paraguayan Surgical Societies in 1968 of seven cases of severe gastrointestinal hemorrhage owing to a heavy infestation of hookworms.These seven cases were encountered at the Baptist Hospital in Asuncion, Paraguay, where I was then serving as chief of the surgical service. The first patient treated was a 2-year-old child who was admitted with a hemoglobin level of 2 g/dL and multiple bowel movements of blood that varied from black to bright red. Sigmoidoscopy and barium enema results were normal. Examination of the fecal material for parasites showed innumerable eggs of the parasite Ancylostoma. Eight blood transfusions were given that only temporarily improved the child's condition. An abdominal exploration showed edema and inflammation of
McDowell DE. Intestinal Bleeding Caused by Hookworm. JAMA. 1981;246(24):2806. doi:10.1001/jama.1981.03320240016008