Intestinal Ascariasis in the Modern Era and the Role of Surgery: A Prospective Observational Study

Background: Intestinal ascariasis remains a leading cause of pediatric bowel obstruction in endemic regions. This study aimed to analyze contemporary presentation patterns, diagnostic approaches, and surgical outcomes of ascaris-induced intestinal obstruction in children. Methods: A prospective observational study was conducted at a tertiary care center over 32 months. All pediatric patients (2-16 years) presenting with intestinal obstruction were evaluated. Demographics, clinical presentation, diagnostic investigations, management strategies, and outcomes were systematically recorded. Conservative management was attempted for 24 hours in appropriate cases, with surgical intervention reserved for failed conservative treatment, complete obstruction, or peritoneal signs. Results: Of 190 children with intestinal obstruction, 120 (63.15%) had ascariasis-induced obstruction. Male predominance was observed (2:1 ratio) with peak incidence in 2-8 years age group (57.89%). Conservative management was successful in 65 of 80 patients (81.25%). Fifty-five patients (45.83%) required surgical intervention: milking of worms (36.36%), enterotomy with worm removal (32.73%), and bowel resection with anastomosis (30.91%). Post-operative complications occurred in 8 patients (14.55%), including surgical site infection (7.27%), anastomotic leak (3.64%), and burst abdomen (3.64%). No mortality was recorded. Mean hospital stay was 4.2 days for conservative management and 7.8 days for surgical cases. Ultrasonography demonstrated 96.47% diagnostic accuracy with characteristic "bull's eye" and "railway track" appearances. Conclusion: Ascariasis remains the predominant cause of pediatric intestinal obstruction in endemic areas. While conservative management succeeds in appropriately selected cases, surgical intervention with acceptable morbidity rates is often necessary. Early recognition and prompt treatment minimize complications and ensure favorable outcomes.