Computed Tomographic Appearance of Massive Intestinal Ascariasis in a Pediatric Patient

Ascaris lumbricoides is among the most common intestinal helminths worldwide but is encountered less frequently in the United States. Although uncomplicated ascariasis is diagnosed clinically and by stool examination, imaging becomes important when intestinal obstruction or another complication is suspected. We report a nine-year-old boy who had recently emigrated from Guatemala and was transferred from an outside emergency department for severe abdominal pain and concern for small bowel obstruction. Computed tomography (CT) demonstrated an extensive burden of elongated, curvilinear intraluminal structures throughout the small bowel, several containing central gas, with associated bowel dilatation. Notably, the initial outside interpretation favored fecalized bowel contents, and the diagnosis was recognized only after the history of vomited worms prompted a radiology addendum. Stool examination confirmed A. lumbricoides ova. The child was managed conservatively with albendazole and bowel cleanout, and serial abdominal radiographs demonstrated progressive reduction in the visible worm burden without surgery. This case illustrates both the striking imaging appearance of massive intestinal ascariasis and a clinically important diagnostic pitfall in its recognition.