Small bowel volvulus secondary to ascariasis in a 7-year-old boy: a case report

Ascariasis, caused by Ascaris lumbricoides, is the most common soil-transmitted helminth infection worldwide, particularly in low- and middle-income countries. While most cases remain asymptomatic, heavy worm infestations may lead to severe complications, including bowel obstruction. Small bowel volvulus secondary to ascariasis is exceedingly rare and potentially fatal, especially in children.

We report the case of a 7-year-old boy from rural Ethiopia who presented with acute abdominal pain, distension, and vomiting. Examination revealed peritonitis and imaging demonstrated small bowel obstruction. Exploratory laparotomy revealed massive Ascaris infestation with a 270° ileal volvulus and a 20 cm segment of gangrenous ileum. Resection with primary end-to-end anastomosis was performed, and multiple worms were extracted intraoperatively. The patient recovered uneventfully and was discharged on anti-helminthic therapy, with subsequent follow-up showing no recurrence.

Secondary small bowel volvulus due to Ascaris infestation is a rare but serious surgical emergency. The obstructive burden of heavy worm load, particularly near the ileocecal valve, can precipitate volvulus with ischemic complications. Imaging aids diagnosis, but definitive management requires timely laparotomy with resection of nonviable segments. Postoperative anti-helminthic therapy and preventive public health measures remain essential to reduce morbidity in endemic regions.

Small bowel volvulus with gangrene is a rare but life-threatening complication of ascariasis in children. In endemic regions, parasitic infestation should be considered among the possible causes of volvulus. Definitive management relies on timely surgical intervention, while preventive deworming programs remain essential to reduce the burden of such severe complications.