Small bowel obstruction secondary to Strongyloides stercoralis: a rare cause and mimic of inflammatory bowel disease

An immunocompetent man in his 60s with no prior medical or surgical history presented with 1 week of progressive abdominal pain, vomiting and obstipation. CT demonstrated a distal ileal small bowel obstruction with segmental inflammatory changes raising concern for new Crohn’s disease. Further history revealed ingestion of untreated tank water, prompting suspicion for a parasitic infection. This was further supported by the presence of peripheral eosinophilia. Empirical treatment with ivermectin was commenced, resulting in complete clinical resolution and normalisation of eosinophils. This case highlights Strongyloides infection as an important mimic of inflammatory bowel disease and an under-recognised cause of small bowel obstruction. Misdiagnosis poses a significant risk to the patient, as this could lead to life-threatening hyperinfection if corticosteroid therapy is initiated.