Ileal perforation due to <i>Ascaris lumbricoides</i> : an incidental finding in ileostomy complicated by peritonitis

Ascariasis, caused by <i>Ascaris lumbricoides</i>, is the most common helminthic infection worldwide, mainly in developing countries. Although intestinal obstruction is its most frequent complication, intestinal perforation with peritonitis is rare and life-threatening. A 45-year-old woman from a rural area presented with cramping abdominal pain, intermittent fever, and asthenia for 3 months. Emergency laparotomy revealed generalized peritonitis due to ileal perforation, managed with ileal resection and ileostomy. Postoperative complications included respiratory failure, septic shock, and three reoperations for eventration, adhesive syndrome, and hemorrhage. On postoperative Day 33, a 20 cm <i>A. lumbricoides</i> worm was expelled through the ileostomy. Intestinal perforation likely resulted from pressure-induced ischemia by a worm mass. Diagnosis can be delayed due to nonspecific symptoms and absent eosinophilia. Ascariasis should be considered in the differential diagnosis of intestinal perforation in endemic areas. Early surgical intervention, clinical suspicion, and preventive measures are key to improving outcomes.