## **Core Concept**
Ileal obstruction due to a roundworm is a condition where a bolus of roundworms (typically *Ascaris lumbricoides*) accumulates and causes a mechanical blockage in the ileum, leading to intestinal obstruction. This condition requires prompt treatment to relieve the obstruction and prevent complications. The management involves both medical and potentially surgical interventions.

## **Why the Correct Answer is Right**
The correct answer, **D. Albendazole and Laparotomy**, involves a two-step approach. Initially, **albendazole** is an antiparasitic medication effective against *Ascaris lumbricoides*. However, in cases of intestinal obstruction caused by a large bolus of worms, medical management alone might not be sufficient to immediately relieve the obstruction. **Laparotomy**, a surgical incision into the abdominal cavity, may be necessary to physically remove the obstructing worm bolus and assess for any potential intestinal damage. This approach addresses both the parasitic cause and the mechanical obstruction.

## **Why Each Wrong Option is Incorrect**
- **Option A: Gastroscopy and Mebendazole** - Gastroscopy is not the appropriate method for diagnosing or treating ileal obstruction. Mebendazole is an antiparasitic drug but does not address the immediate need to relieve mechanical obstruction.
- **Option B: Laparoscopy and Piperazine** - Laparoscopy might be used in some cases for diagnostic purposes but is less commonly used for therapeutic interventions in acute obstruction. Piperazine can be used to treat ascariasis but, like mebendazole, does not immediately relieve mechanical obstruction.
- **Option C: Conservative management and Ivermectin** - Conservative management might include bowel rest, fluids, and antiparasitic medication like ivermectin. However, this approach may not be sufficient in cases of complete obstruction or when there is evidence of bowel ischemia.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that while antiparasitic medications are crucial for treating the parasitic infection, they do not immediately relieve mechanical obstruction. In cases of intestinal obstruction due to a roundworm bolus, surgical intervention may be urgently required to prevent complications such as bowel ischemia or perforation.

## **Correct Answer:** **D. Albendazole and Laparotomy**