Acute appendicitis and Enterobius vermicularis infestation

Abstract

A 9-year-old Canadian boy presented to the emergency department with a 4-day history of sudden, unremitting pain in the right iliac fossa. His medical history was otherwise unremarkable, and he had not travelled recently. The patient was afebrile, and physical examination showed focal tenderness at the McBurney point. His total leukocyte count was 10.8 (normal 4.5-11.0) × 10 9 cells/L with a normal differential, and ultrasonography did not visualize the appendix. We diagnosed acute appendicitis and performed an urgent laparoscopic appendectomy.After resecting a mildly inflamed appendix, we noticed that 8 live helminths dropped into the peritoneal cavity ( Figure 1). All helminths were retrieved via endoscopic suctioning and a proviodine wash. We removed the appendix using a specimen retrieval bag. Tissue examination showed reactive lymphoid hyperplasia with intraluminal and submucosal pinworms (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181194/-/DC1). Our patient recovered in 12 hours, and we administered 1 dose of albendazole in hospital with a prescription for a second dose in 2 weeks. We prescribed the same regimen as a preventive measure for household contacts. When informed of the findings, our patient reported a 1-week history of anal pruritus preceding his abdominal pain. He also recalled similar anal pruritus 2 years earlier when he had been diagnosed with Enterobius vermicularis (pinworm) infection, which was treated by pyrantel pamoate.Although pinworm infestation is the most common intestinal helminth infection worldwide, simultaneous E. vermicularis infection and appendicitis is rare in Canada, accounting for less than 0.6% of all appendicitis presentations. 1-3 It is likely that no causal relation exists between appendicitis and pinworm infection, as appendiceal inflammation is not typically found. 2 Nocturnal anal pruritus remains the most important clinical symptom of E. vermicularis infestation, a result of female pinworms laying eggs within the anal verge at night. 2,4 Laparoscopic appendectomy is the definitive treatment for appendicitis, followed by either mebendazole or albendazole for complete pinworm eradication. Prophylaxis is recommended for household contacts. [2][3][4] This article has been peer reviewed.The authors have obtained parental consent. Affiliations:

The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis

“…The presence of E. vermicularis infection in appendicitis was firstly reported by Fabrius in [90]. Since then, researchers have performed many studies on this line [36,38,91]. This systematic review is the first of that brings information to reveal global status of E. vermicularis infection in appendicitis cases.…”

Acute appendicitis caused by Enterobius vermicularis: Observations from a case report

“…Nevertheless, some parasitic agents such as Schistosoma spp, Taenia spp and Ascaris lumbricoides have been reported as the causative agent [ 11 , 12 ]. Based on the literature, few cases of appendicitis caused by E. vermicularis have been reported in Asia and Canada [ 13 , 14 ]. Despite the widespread prevalence of this parasite mainly in the tropics [ 2 ], our patient was most probably infected in France based on her medical record.…”

The Prevalence of Pinworm, Incontinence, and Appendicitis in Children in Diwaniyah Governorate, Iraq

“…109 appendixes were collected from the Women and Children hospital and Al-Diwaniya Teaching Hospital in Diwaniya Governorate, where the excised appendages were placed in sterile plastic containers containing Normal saline in order to preserve their internal contents until examination and verification of the causes of inflammation associated with the appendix and learned bottles and transferred to the laboratory for the purpose of measuring their length and diameter, as well as microscopic examination, where the process of appendicular appendages were examined microscopically in three ways namely the method of direct swab, examination by sedimentation, examination by the method of floating (18).…”

“…After the appendix is examined microscopically and the type of infected is recorded, it is stored in new bottles with the patient's name and age containing formalin at a concentration of 10% about 48 hours at room The sections were washed with normal saline for 2 hours, after which the tissue was treated by routine treatment methods as follows: Dehydration, Clearing, Infiltration, Embedding, Sectioning, Mounting, Rehydration, Staining, Drying, clearing and labeling (18,20).…”