Gastrointestinal Ascariasis: Unusual Presentation in 2 Cases

Ascariasis is a helminthic infection caused by the nematode Ascaris lumbricoides and remains the most prevalent helminth infection worldwide. Although typically asymptomatic or limited to intestinal symptoms, intestinal ascariasis can present unusually as demonstrated in these two cases. The first case involves a 73-year-old male who was being treated for non-steroidal anti-inflammatory drug (NSAID) - induced upper gastrointestinal bleeding (UGIB) and was incidentally found to harbor Ascaris worms in the duodenum during endoscopy. The second case describes a 63-year-old male with decompensated liver cirrhosis who began vomiting and passing large quantities of Ascaris worms while hospitalized. Both patients responded excellently to anthelminthic therapy. The first case highlights the need to consider ascariasis in the differential diagnosis of upper gastrointestinal bleeding, either as a primary cause or in conjunction with other causes of upper GI bleeding. The second case underscores the importance of considering biliary ascariasis or ascariasis co-infection in patients with liver cirrhosis. Ascariasis continues to pose a significant public health challenge. Effective preventive strategies such as improved sanitation, enhanced personal hygiene, and routine deworming programs are crucial for reducing the disease burden and averting potentially severe complications.