“Worm within worm”: acute appendicitis containing an adult Ascaris lumbricoïdes

Abstract

Appendicitis is the first aetiology for abdominal surgical emergency. Ascariasis is the most common helminth infection in tropical countries where it is endemic. The ability of intestinal helminths to wander through the digestive system means that it can end up in the appendix lumen and lead to appendicitis by luminal obstruction. However, this presentation is still rarely described in the literature. In fact, most of the diagnoses of roundworm associated with appendicitis are made retrospectively by the discovery of its eggs on the pathological examination of an appendectomy specimen. We report the case of a 7-year-old patient living in a tropical area who consulted for acute right lower quadrant pain. The ultrasound suspected the diagnosis of appendicitis and also revealed multiple intestinal worms including one in contact with the inflamed appendix. Surgical exploration confirmed appendicitis associated with roundworm partly in the appendicular lumen through a perforation.

Foreign Body Appendicitis Coexisting With Ascariasis in a Pediatric Patient: A Case Report

“…The involvement of Ascaris lumbricoides , a common intestinal parasite, in causing appendicitis is controversial; while it can migrate to the appendix, mimicking appendicitis symptoms, its role as a direct causative agent remains unclear [ 5 ]. Suspected appendicitis due to roundworm is commonly confirmed through the identification of roundworm eggs in the appendectomy specimen [ 6 ]. Wani et al found in their study that while 72.7% of patients with Ascaris lumbricoides underwent surgical treatment, only 27.2% showed histopathological evidence of appendicitis linked to Ascaris lumbricoides [ 7 ].…”