Small bowel obstruction due to

Ascaris lumbricoides is the most common soil-transmitted helminth affecting humans, predominantly in low-income countries. Although usually asymptomatic, heavy infestation can lead to serious complications such as intestinal obstruction, particularly in children whose narrower intestinal lumen predisposes them to luminal blockage by worm boluses. A 6-year-old male child presented to the surgical emergency department of Tibebe Ghion Specialized Teaching Hospital, Northwest Ethiopia, with 3 days of severe crampy, centrally located abdominal pain and frequent vomiting. Examination revealed classic signs of intestinal obstruction. Laboratory tests showed leukocytosis with marked eosinophilia. Abdominal radiography demonstrated multiple air‑fluid levels consistent with small bowel obstruction. After preoperative stabilization, exploratory laparotomy revealed massively distended, congested small bowel filled with Ascaris worms, necessitating enterotomy with extraction of 59 live worms, as milking was unsuccessful due to dense impaction and thinning of the bowel wall. Postoperatively, the patient recovered uneventfully. Ascariasis should be considered in children presenting with intestinal obstruction in endemic regions. Early recognition and timely surgical intervention are essential for favorable outcomes.