Massive Ascariasis Causing Extensive Jejunoileal Necrosis and Septic Shock in a Toddler

A 2.5-year-old boy who had recently migrated from a northern highland area of Vietnam to the south presented with fever, diarrhea, progressive respiratory distress, and severe abdominal distension. He was referred in septic shock, requiring mechanical ventilation and two vasopressors. Emergency laparotomy revealed complete jejunoileal obstruction from a dense bolus of more than 100 Ascaris lumbricoides worms and approximately 70 cm of transmural bowel necrosis. Segmental resection, complete worm extraction, and primary end-to-end anastomosis were performed. Histopathology confirmed transmural hemorrhagic infarction consistent with ischemic necrosis from mechanical obstruction. The child recovered after intensive care, antimicrobial treatment, transfusion support, and a single oral dose of albendazole after postoperative stabilization and return of oral intake; he was discharged on postoperative day 20 and remained well at 2 months when a second single dose of albendazole was administered. Massive ascariasis should remain a differential diagnosis in children with acute abdomen in endemic settings or after migration from endemic areas.