Bilious Worm Emesis Secondary to Intestinal Helminthic Infection.

A five-year-old male from West Virginia presented to the emergency department with abdominal pain and non-bilious emesis. Initial social history was unrevealing. Labs were significant for leukocytosis with neutrophilia. Early management included fluid resuscitation and inpatient observation for dehydration suspected secondary to viral gastroenteritis. On hospital day 1, the patient developed bilious emesis. An upper gastrointestinal radiographic series with small bowel follow through demonstrated delayed contrast passage through the duodenum. Subsequent episodes of bilious emesis contained a 24 centimeter (cm) live worm (Figure 1).