One of the most prevalent parasitic infestation is ascariasis which poses a great challenge to both the person being infested with and the treating medical team. We present here a case of round worm () infestation. A 40-year-old male, weighing 60 kg, diagnosed as perforation peritonitis, was scheduled for emergency exploratory laparotomy. The round worm was crawling out from duodenal perforation vent during laparotomy confirming the infestation. Patient later developed bronchospasm in post-extubation period and was managed accordingly. Surprisingly the patient expelled an adult worm in the next morning. This report highlights the importance of anticipating complications (i.e., airway obstruction, bronchospasm, etc.,) in an undiagnosed case of round worm infestation, especially if routine investigations were within normal limits.