Gastrointestinal Ascariasis: Unusual Presentation in 2 Cases
Main Article Content
Keywords
Ascariasis, Gastrointestinal (GI) bleeding, Liver Cirrhosis
Abstract
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.
References
2. World Health Organization. Soil-transmitted helminth infections [Internet]. Geneva: WHO; 2023 [cited 2025 Jun 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections
3. Muller R. The nematodes. In: Worms and Human Disease. 2nd ed. Wallingford (UK): CABI; 2002. p. 109–235.
4. Holland C, Sepidarkish M, Deslyper G, et al. Global prevalence of Ascaris infection in humans (2010–2021): a systematic review and meta-analysis. Infect Dis Poverty. 2022;11:113. https://doi.org/10.1186/s40249-022-01038-z
5. Funso-Aina OI, Chineke HN, Adogu PO. A review of prevalence and pattern of intestinal parasites in Nigeria (2006–2015). Eur J Med Health Sci. 2020;2(1). doi:10.24018/ejmed.2020.2.1.139
6. Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone; 2010. p. 3577–80.
7. Leung KC, Leung AM, Wong HC, Hon KL. Human ascariasis: an updated review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(2). doi:10.2174/1872213X14666200705235757
8. Quinnell RJ. Genetics of susceptibility to human helminth infection. Int J Parasitol. 2003;33(11):1219–31.
9. Abdullah R. Live Ascaris lumbricoides in the peritoneal cavity. Ann Saudi Med. 2007;27(2):118–21. doi:10.5144/0256-4947.2007.118
10. Xie TH, Fu Y, Ren XX, Sun XL, Wang Q, Sun Q. Ascaris lumbricoides as a rare cause of gastric perforation: a case report and brief literature review. Front Med (Lausanne). 2025;11. doi:10.3389/fmed.2024.
11. Jacob GS, Nakib BA, Ruwaih AA. Ascariasis producing upper gastrointestinal hemorrhage. Endoscopy. 1983;15:67.
12. Blish CA, Sangaré L, Herrin BR, Richardson BA, John-Stewart G, Walson JL. Changes in plasma cytokines following treatment of Ascaris lumbricoides in HIV-1 infected individuals. J Infect Dis. 2010 Jun 15;201(12):1816–1821. doi: 10.1086/652784. PMID: 20441516; PMCID: PMC2946624
13. Marie C, Petri WA. Ascariasis. In: Porter RE, editor. The Merck Manual of Diagnosis and Therapy. Rahway (NJ): Merck & Co Inc; 2022 [rev. Sept 2022].
14. Sanai FM, Al-Karawi MA. Biliary ascariasis: report of a complicated case and literature review. Saudi J Gastroenterol. 2007;13:25–32.
15. Hefny AF, Saadeldin YA, Abu-Zidan FM. Management algorithm for intestinal obstruction due to ascariasis: a case report and review of the literature. Ulus Travma Acil Cerrahi Derg. 2009;15(3):301–5. PMID:19562557.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.