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Jim prepares to shoot a Flying Fish with his Plasma Blaster in "Intestinal Distress" (Genesis version)

Intestinal Distress is the penultimate (second-to-last) level in the original Earthworm Jim video game.

Intestinal Distress a slightly gross level that takes place in the guts of some grotesque, giant unknown living creature. It is the dwelling place of numerous enemies and the boss Doc Duodenum, who Jim must defeat in order to progress to the final level.

Game manual description[]

"Disgusting gross bad guys (did you expect anything less?), Flying Fish? And a boss that will put a major squeeze on you? Now, would you like to see what you just had for lunch?"[1]


The stage itself is filled with dangers such as acidic fluids, spikes, Flying Fish, Pill Bugs, Small Gutballs, Large Gutballs and other things found inside intestinal tracts. Although most enemies in this level are relatively harmless, with predictable patterns, the greatest dangers in this level are the larger rolling and bouncing enemies, whose attacks can cause serious damage. "Wind-pipes" is used to "blow" Jim up to higher areas. Strange, fleshy strings can be used to hang onto. The boss is Doc Duodenum, a living incarnation of the slightly obscure human organ.


"Intestinal Distress" was first included in Shiny Entertainment's original 1994 release of the game on the Sega Genesis/Mega Drive. The level was also included a year later for the Special Edition on the Sega CD with updated graphics and sound.

However, the level was notably missing from a large number of ports of the game. "Intestinal Distress" was omitted entirely from all Nintendo releases of the original game due to Nintendo's anti-blood/gore policies, which were much more stringent than Sega's. The level was also not included in the Special Edition's DOS release due to Rainbow Art's technical difficulties in porting the level.

"Intestinal Distress" was included in the 2002 Nintendo Game Boy Advance port, although the layout has been changed a bit, and the background tiles are so mangled that it's incredibly confusing to navigate.

"Intestinal Distress" was reinstated in full, and in high-definition, for the single-player mode of the 2010 HD remake. Earthworm Jim HD also included two online multiplayer-exclusive levels based on "Intestinal Distress", called Food Intoxication and Gastric Issues.




Earthworm Jim Special Edition - Intestinal Distress Sega CD Music

Tommy Tallarico's music from the Special Edition

  • It is never stated what giant creature this level takes place in, and the giant creature is never seen from the exterior.
  • Given that the next level is Buttville, the final level in the game, it is possible that Intestinal Distress also takes place on Insectika, and that the giant creature is some of guardian or gatehouse for Queen Slug-for-a-Butt.
  • Alternatively, the level may take place on another planet entirely. This would seem more likely since the seventh and final iteration of Andy Asteroids? takes place between Intestinal Distress and Buttville.


  1. Special Edition game manual