Ascariasis is usually managed conservatively with medical therapy but surgery may be indicated when medical management fails or complications arise.^[1]

Some of the indications for the surgical management of ascariasis include:^[1]

• Complete intestinal obstruction with inadequate decompression
• Lack of response within 24-48 hrs of medical management of obstruction
• Complications such as volvulus, intussusception or intestinal perforation
• Acute appendicitis
• Worms trapped in ducts
• Liver invasion by worms

The surgical management for hepatobiliary infestation with ascaris include:^[2]

• Endoscopic management: This entails endoscopic extraction of the worm

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• Laparoscopic management: This often entails laparoscopic cholecystectomy, common bile duct exploration with parasite extraction, and T-tube placement.

Intestinal obstruction from ascariasis can be surgically managed via the following methods:^[3][1]

• External “milking” of the obstructing bolus of worms from the ileum into the colon
• Enterotomy to manually extract the worms

• Intestinal resection and end-to-end anastomosis if necessary