A 69-year-old Ecuadorian woman complained of a 4-month history of severe nuchal pain. Her past medical problems included long-standing rheumatoid arthritis requiring the replacement of multiple joints. She had moved to the United States from Ecuador 1 month previously. At presentation, x-ray examination showed impacted cervical vertebral bodies. She denied any gastrointestinal or pulmonary symptoms. She was later admitted for corrective cervical fusion, grafting of bone, and placement of orthopedic hardware. On the first postoperative day, while she was under the influence of general anesthesia, a cylindrical moving object emerged from her mouth. Gross examination revealed a roundworm measuring 22 cm long with an uncoiled tail and a prominent convoluted uterus (Figure 1, ×1). Stereoscopic examination of the head revealed a mouth with 3 distinct lips characteristic of Ascaris lumbricoides (Figure 2, lateral view, ×3.75; and Figure 3, anterior view, ×3.75). The patient is currently being treated with antihelmintic therapy.