Thiscasestudypresentsthecomplexclinicalscenarioofa26-year-oldBangladeshimalewho initially presented with epigastric and umbilical pain, ultimately leading to the diagnosisof acute peptic ulcer perforation with concurrent ascariasis. The patient's clinical course, fromthe initial presentation with abdominal pain to the unexpected intraoperative discovery of liveroundwormsemergingfromaduodenalperforation,highlightstheintricatediagnosticchallenges andtherapeuticintricacies encounteredinmanagingdualpathologies. The discussion explores the epidemiology, pathophysiology, and clinical manifestations ofacutepepticulcerperforationandascariasisindividually,emphasizingthediagnosticcomplexitieswhen these conditionscoexist. Additionally, themultidisciplinaryapproachemployed in the surgical management of the patient is dissected, shedding light on the needforacomprehensivestrategywhenfaced withsuch uniqueclinicalpresentations. This case study contributes to the medical literature by unraveling the mysteries surroundingthe simultaneous occurrence of acute peptic ulcerperforationandascariasis. It underscorestheimportanceofheightenedclinicalsuspicion,thoroughdiagnosticevaluation,andacollaborative, multidisciplinary approach to navigate the intricate landscape of abdominalpathology.