what is your diagnosis?

Ba study. My gastro room

Ascaris lumbricoides  is a roundworm that inhabits the small bowel of approximately one-fourth of the world’s population. 
Adult worms grow to as much as 35 cm in length and may live 6 to 12 months. 
They are transmitted via the fecal-oral route. 
Most people are asymptomatic but can present with vague abdominal pain, nausea, vomiting, nutritional deficiency, or a history of passing worms orally or rectally. Complications of ascariasis include mechanical small bowel obstruction, volvulus, or intussusception.
The worms may penetrate the intestinal mucosa and migrate to the lungs, where they can cause bronchopneumonia.
They can also lodge in the pancreaticobiliary ductal system, causing pancreatitis, cholecystitis, or liver abscess.  
On barium studies, an  Ascaris  is an elongated, worm-like filling defect in the small bowel. Two worms seen side by side look like tram-tracks. 
On delayed images, barium ingested by the worm may highlight the worm’s slender intestinal tract. 
On ultrasound, worms are hypoechoic, occasionally writhing tubular structures with echogenic walls, with the digestive tract of the worm forming two similar echogenic lines. 
CT is helpful in confirming complications associated with infestation.