High-grade partial intestinal obstruction caused by Ascaris lumbricoides: a case report

Introduction: Ascaris lumbricoides is the most common helminthic parasite affecting humans, predominantly in tropical and subtropical regions with poor sanitation. While often asymptomatic, heavy infestations can lead to serious complications, including intestinal obstruction. Though rare in adults, Ascaris-related obstruction requires timely recognition and management to prevent life-threatening outcomes. Case presentation: We report a case of a 56-year-old male who presented with a 3-day history of abdominal pain, nausea, vomiting, and abdominal distension. Imaging studies revealed dilated small bowel loops with a high-grade partial obstruction at the jejunum. Despite conservative management, the patient required surgical intervention. Intraoperatively, an obstructing mass of worms was identified and resected. Clinical discussion: Intestinal obstruction due to A. lumbricoides is the most frequent surgical complication of ascariasis, commonly involving the terminal ileum. In this case, however, obstruction occurred in the jejunum, highlighting the varied presentations of this condition. Diagnosis relies on imaging modalities such as computed tomography scans, which may reveal characteristic findings like dilated bowel loops and worm clusters. Treatment involves conservative measures initially; however, surgical intervention is required in cases of nonviable bowel or complete obstruction. Conclusion: This case emphasizes the importance of considering A. lumbricoides as a differential diagnosis for small bowel obstruction, even in adult patients in non-endemic regions. Early recognition, appropriate imaging, and timely surgical intervention are key to preventing complications and improving outcomes. Preventive measures, including public health initiatives to enhance sanitation and routine deworming programs, remain essential in reducing the global burden of ascariasis.