A five-year-old male presented with small bowel obstruction and a worm bolus on a plain abdominal radiograph. Peritonism and acidosis prompted laparotomy after a short period of resuscitation. At surgery a worm bolus had caused a small bowel volvulus with a segment of necrosis that was successfully managed by detorsion and resection. This highlights that though ascaris lumbricoides, a common parasite in impoverished communities, has many mild manifestations the most life-threatening complication is volvulus. Hence when worm bolus is suspected vigilant observation to detect sepsis, acidosis and peritonism is essential to expedite surgery and prevent the morbidity of perforation.