Ascariasis--its complications, unusual presentations and surgical approaches.

Serious complications of ascariasis are varied and occur at all stages of worm development. The acute condition within the abdomen heralds the presence of intestinal, pancreatic, or biliary tract obstruction secondary to the physical presence of the adult parasites. Larvae may be responsible for acute respiratory disease, either as a direct allergic phenomenon or as a pneumonic infiltrative process secondary to fellow traveler bacteria. Deposition of ova in the liver allows for intrahepatic and pericholangitic abscesses with resultant parenchymal destruction and scarring. Though primary therapy is medical, specific indications for surgical intervention are discussed. These unusual but life-threatening sequelae are typified in the case presentation of a critically ill child.