A poor, 6 year old girl presented with recurrent abdominal pain, altered bowel habit, anorexia, and weight loss. She had been in close contact with people with tuberculosis. She was anaemic and failing to thrive, and her abdomen was distended, with a vague mass in her umbilical region. An ultrasound scan showed dilated bowel loops. Despite investigations proving negative, we presumed a diagnosis of intestinal tuberculosis, and, in keeping with local custom, we started treatment. But she failed to improve, and a barium follow-through examination showed a typical whirlpool pattern of an intraluminal worm bolus, which didn't respond to conservative management. She needed a laparotomy to move the bolus from the ileum into the colon. The next day she passed numerous roundworms (Ascaris lumbricoides) and recovered well.
