Intermittent Ileitis and Partial Small-Bowel Obstruction Due to Intestinal Helminth Infection Mimicking Crohn's...

Intestinal helminth infections may present with chronic gastrointestinal symptoms and can mimic inflammatory or obstructive bowel pathology, leading to diagnostic challenges. A 27-year-old previously healthy male presented with nine months of intermittent abdominal pain, nausea, and bloating with concern for partial small-bowel obstruction. He reported frequent hunting and environmental exposure associated with field dressing and preparation of wild game. Imaging demonstrated distal ileal wall thickening with upstream dilatation, and laboratory studies revealed marked peripheral eosinophilia. Despite negative stool ova and parasite testing performed after endoscopic retrieval of the parasite, colonoscopy identified a live helminth in the terminal ileum, which was retrieved endoscopically. Histopathologic evaluation demonstrated an intestinal nematode most compatible with Ascaris lumbricoides.​​​​​ Treatment with a single 400-mg oral dose of albendazole resulted in rapid symptom resolution and sustained clinical improvement on follow-up. This case emphasizes the importance of obtaining a detailed exposure history and maintaining suspicion for parasitic infection in patients with chronic gastrointestinal symptoms, eosinophilia, and small-bowel inflammation, even when stool studies are negative.