Intestinal perforations by worms are rare. Ascariasis is the commonest helminthic infestation in the world. Ascariasis must be considered as a differential diagnosis in intestinal obstruction and perforation especially in endemic regions. The clinical presentation can vary from an asymptomatic patient to severe complicated disease. Symptoms depend on the intestinal worm load and intestinal obstruction is a common complication. Because of the rarity of helminthic intestinal perforations and more so given the large-scale migration from developing countries, we wish to emphasize the need to inculcate awareness among treating clinicians, even from the developed world, about this potentially dangerous yet treatable condition. Early diagnosis and treatment is crucial to prevent significant mortality and morbidity from disease complications. Conservative treatment is advised for uncomplicated intestinal Ascariasis. Surgery is life saving in Ascaris complications. There is no effective vaccine available till date. Prevention is better than cure. We present a case series analysis of five children with worm infestation and intestinal perforation, and report clinical presentations, imaging modalities used, treatment and outcomes for each of the case.
