Disseminated Peritoneal Nematode Infestation Causing Adhesive Small Bowel Obstruction and Bowel Gangrene Following Perforated Appendicitis: A Case Report.

Disseminated peritoneal nematode infestation is a rare extra-intestinal manifestation of ascariasis, typically occurring following bowel perforation. We report a case of a male in his 60s presenting with features of acute small bowel obstruction, including abdominal pain, distension, obstipation, and bilious vomiting, with a history of perforated appendicitis managed surgically six months prior. Contrast-enhanced computed tomography suggested small bowel obstruction. Intraoperative findings revealed dense adhesions, gangrenous ileum, and multiple nodular lesions over the small bowel, mesentery, and omentum. Resection of the gangrenous segment with primary anastomosis was performed. Histopathological examination confirmed nematode infestation with associated granulomatous inflammation. The findings suggest transperitoneal dissemination following prior appendicular perforation. This case highlights a rare presentation of ascariasis mimicking granulomatous disease and emphasizes the importance of considering parasitic etiologies in atypical intra-abdominal pathology, particularly in endemic regions.