In adults as well as children, barium examination of the small bowel will clearly show the outlines of individual ascarids as elongated radiolucent filling defects within the barium column. The worms are characteristically long, smooth, cylindrical, and often coiled in outline (Figs. 10.18, 10.19, 10.20). The vast majority of ascarids will be found in the jejunum and ileum (Figs. 10.20, 10.21, 10.22). Rarely, the worms can migrate into the stomach (Figs. 10.18 and 10.19) and esophagus (Fig. 10.33B), especially when there has been vomiting.

....

Fig. 10.18A-C. Ascaris in the stomach and proximal small bowel of a 36-year-old Korean woman with complaints for four days suggesting gallbladder disease. She had right upper quadrant pain, nausea, vomiting, and a palpable mass in the right upper quadrant. The gallbladder did not visualize on two successive oral cholecystograms. An upper GI series (A, B and C) revealed multiple ascarids in the stomach and proximal small bowel. Of 100 patients with ascariasis seen at a U.S. Army Hospital in Korea during a 1 year period, this was the only one with ascarids in the stomach. Note that one Ascaris is protruding through the antrum and pylorus into the duodenal bulb and C-loop. It is presumed that the ascarids caused the patient's initial symptoms by blocking the ampulla of Vater, and some may have migrated into the common duct itself. Alternatively, she may have had gallbladder disease with the 4 days of nausea and vomiting causing the ascarids to migrate retrograde into the stomach in search of food. Note the different positions and attitudes of the worms from film to film during the examination due to active movement of the worms and peristalsis of the stomach. (Courtesy of Dr. William Harshaw, Oakton, Virginia.).

.....

....

Fig. 10.19 Ascariasis of the stomach and duodenum in three different patients. (A) Ascarids in the duodenal bulb and C-loop in a patient from Africa. (B) A large bolus of ascarids in the duodenum of a Brazilian. There are several worms in the stomach also. (C) Large tangled masses of ascarids in the stomach and duodenum of a child from Zimbabwe causing gastroduodenal obstruction. (D) Gross specimen showing the multiple intertwined ascarids blocking the duodenal C-loop of patient B. (B and D Courtesy of Dr. Antonio Filho, Sao Paulo).

.....

Fig. 10.20. Ascariasis of the jejunum and ileum. (A) Radiolucent outlines of multiple long cylindrical ascarids within the jejunum of a Brazilian patient. (B) Numerous ascarids are seen within the jejunum and ileum of another patient. There is also coarsening of the mucosal pattern and marked fragmentation and segmentation of the barium column suggesting malabsorption. Ascariasis may be an associated finding in some patients with malabsorption although its exact role in these patients is unclear.