Infection with the roundworm Ascaris lumbricoides is common in children and may mimic an acute abdomen. The cases of two pediatric patients who presented to the emergency department with signs and symptoms of a surgical abdomen are presented to highlight the presentation of this infection. Both cases were diagnosed by physical examination and radiographs and were treated successfully without surgical intervention. These cases illustrate the need for heightened awareness by the emergency physician of ascariasis in the differential diagnosis of acute abdomen.