Echoes from Macondo: managing disseminated ascariasis with extracorporeal membrane oxygenation therapy. A case report

Ascaris lumbricoides is one of the most prevalent helminthic infections worldwide, yet disseminated disease is rare. In resource-limited settings, delayed diagnosis can lead to severe complications, including multiorgan dysfunction and acute respiratory distress syndrome (ARDS). There are only sporadic case reports describing the management of this entity with mechanical circulatory support such as extracorporeal membrane oxygenation (ECMO). We report the case of a previously healthy 2-year-old girl from rural Colombia with a one-month history of abdominal pain and diarrhea. Stool examination confirmed A. lumbricoides infection, and abdominal ultrasound revealed intestinal pseudo-obstruction. Initial management included anti-parasitic therapy and surgery. Patient's condition deteriorated to refractory hypoxemia, biventricular dysfunction, and two cardiac arrests. Peripheral veno-arterial ECMO was initiated by a mobile team in the referring hospital, followed by air transfer to a tertiary center. During the early days of ECMO support, the patient developed complications related to the underlying disease, including anastomotic dehiscence with intraluminal roundworms, bloodstream infection, and cerebral septic emboli, which required repeat surgery and escalation of antimicrobial therapy. After 10 days of ECMO, biventricular and pulmonary recovery allowed decannulation. The patient was discharged one month later in good physical condition, without neurological deficits, and with a pulmonary rehabilitation plan. This case illustrates how extreme socioeconomic disparities can lead to the coexistence of highly preventable parasitic diseases with advanced life-support interventions such as ECMO. Much like the magical realism of One Hundred Years of Solitude, the use of such technology in an isolated, resource-limited setting may seem improbable, yet it reflects a pressing reality. Bridging these contrasts requires both technological capacity and strong public health strategies to close the gaps in knowledge, access, and outcomes.