Ascariasis – Stomach Pain Can Be Due To Worms!

Ultrasound showing hepatic abscess with worms inside the abscess cavity

Ascariasis – worms in the stomach of a 28-year-old male, causing hepatic abscess and requiring drainage and worm extraction under ultrasound guidance.

Parasitic infections caused by roundworms are quite common. Ascaris lumbricoides has infected approximately 1.2 billion people worldwide. It lives in the intestines, lays eggs, which are then passed in the stool. These worms can infect other people (faecal-oral route); in other words, Ascariasis is caused by ingesting these worm eggs, for example, through contaminated hands or fingers, or by eating inadequately washed/cooked vegetables or fruits.

Case presentation:

A 28-year-old, otherwise healthy, male presented to the emergency department with complaints of severe acute abdominal pain in the right upper quadrant. The pain associated with bilious vomiting and high-grade fever. History revealed an episode of jaundice a few days back which had resolved spontaneously without any intervention. The patient had no complaints of constipation, obstipation, or diarrhoea.


On examination in the ER, he was febrile (101 °F), icteric, but well-hydrated. Palpation of the abdomen revealed tender hepatomegaly. However, the rest of the examination was normal.


Serological studies revealed:

  • Haemoglobin level – 10.4 g per deciliter (reference range, 12 to 15)
  • White blood cell count – 12,300 per cubic millimetre (reference range, 4000 to 11,000)
  • Serum bilirubin 6.98 mg/dl (direct 6.42 mg/dl).
  • Mildly elevated liver transaminases

Besides the above, the rest of the laboratory were normal with serum alkaline phosphatase, serum amylase level, and coagulation profile within normal limits.

Abdomen radiograph did not show dilated bowel loops, fluid levels, and gas under the diaphragm,

Therefore, the doctors considered hepatic abscess as a working diagnosis, and they performed an abdominal ultrasound.

Ultrasound Finding:

Ultrasound revealed a large irregular hypoechoic space-occupying lesion in the right lobe of the liver. Moreover, it revealed a coiled echogenic linear structure within the abscess cavity.

To summarize, the findings suggested an Ascaris.

Management of Ascariasis:

Doctors started him on parenteral antibiotics and oral albendazole, and they drained the abscess percutaneously. Additionally, they extracted the worm from the cavity under ultrasound and fluoroscopic guidance.

Patient’s percutaneous catheter was removed on the 7th day, and he was discharged on the 10th day.

During the follow-up visit, the patient was asymptomatic.

The patient, in this case, presented with symptoms, whereas some of the infected people may remain asymptomatic and would be shedding eggs without any signs. Whereas, those who have symptoms, may present with abdominal discomfort/ pain, diarrhoea, etc.; in severe cases, the roundworms can obstruct the intestines. Since Ascaris dwells in the intestines it can consequently slow the growth in children.

Nonetheless, the good news is that Ascariasis is treatable with Anthelmintic medications. Only a few cases, the complicated ones, require surgical interventions.

Who should be screened?

Screen the individuals residing in highly endemic areas. Moreover, deworm the patients from endemic areas before and after elective cholecystectomy to avoid Ascariasis-related complications.


Nag HH, Ji R. Ascariasis presenting as an acute abdomen-a case report. Indian J Surg. 2013;75(Suppl 1):128-130. doi:10.1007/s12262-012-0514-8

Global Health, Division of Parasitic Diseases, and Malaria. (2020, November 23). Ascariasis. Retrieved from Centers for Disease Control and Prevention:

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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