Localized pain may suggest complete intestinal obstruction or appendicitis, as does the presence of nausea and bilious emesis. Ascariasis is often incidentally found after a patient passes an adult worm in feces or through the nose or mouth. Fever, general anesthesia, or sub-therapeutic doses of antihelminths may provoke the worms to migrate. Migrating worms have also been reported to cause intestinal perforation. Biliary tract disease Migration of a single adult worm may obstruct the biliary tree leading to biliary colic, cholangitis, or gallstone formation.
Biliary colic is characterized by sharp, intermittent, right upper quadrant pain.
Toxic appearance and fever suggests the presence of cholangitis. Wheezing on auscultation is the most common finding in symptomatic patients. The presence of rales or decreased breath sounds suggests bacterial pneumonia, which may occur as a result of bronchial obstruction. In the case of complete obstruction, decreased or absent bowel sounds, abdominal tenderness, or signs of frank peritonitis may be found. These conditions include fever and the use of certain antihelminthic agents that cause a spastic paralysis of the worms.