OXYURIASIS AND APPENDICITIS
DEPARTMENT OF GENERAL SURGERY, DR. B R AMBEDKAR MEDICAL COLLEGE, BANGALORE
Presenting Author: Dr. NIRANJANA PB ,Moderator:DR.B.S.RAMESH, PROF AND HOD OF G.S ,DR.BRAMCH
Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth
infection. The simple presence of E. vermicularis in the appendix usually produces symptoms of acute appendicitis. The association
of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide.
CASE 1
A 38-year-old woman with a history of pain
in the right lower quadrant of abdomen which
was localised since 2 weeks, associated with
history of fever, and one episode of vomiting.
•No history of any other co morbid illness.
•General physical examination was
unremarkable, apart from temperature being
99. 4 F
•On systemic examination, tenderness was
present in right iliac fossa , no guarding and
rigidity. Bowel sound were normal
•Blood investigation were within normal limits.
•USG abdomen revealed acute appendicitis
with appendix diameter 8mm.
•Patient was taken up for laproscopic
appendectomy. During the excision of the
appendix following endoloop application ,
incidental presence of gliding worm within the
appendix was identified
• Appendix specimen was sent for HPE
• Post op recovery was uneventful. Post
operatively tab.MEBENDAZOLE was given
• Deworming for the family done .
• HPE showed chronic appendicitis.
Fig 1 A , B showing intraoperative picture of
worm in appendix . And HPE of the same
Arrow shows the worm.
B WARWICK
CASE-2
A 16-year-old BOY with a history of
pain abdomen 4 days , localized to right
lower abdomen with fever and vomitting-
2 episodes
General physical examination was
unremarkable, apart from febrile status.
On systemic examination, tenderness
was present in right iliac fossa , no
guarding and rigidity. Bowel sound were
normal
• Blood investigation were within normal
limits , with 4%- eosinophils
• (TC-7800, E-4%).
• USG abdomen revealed a appendix
with diameter of 6.9 mm , with minimal
periappendicular fluid collection
• Patient was taken up for laproscopic
appendectomy. Fecolith was identied
and worms in the fecolith and
appendicular lumen was visualised.
• Appendix specimen was sent for HPE
• Post op recovery was uneventful. Post
op recovery was uneventful. Post
operatively tab.MEBENDAZOLE was
given
• Deworming for the family done .
HPE showed acute appendicitis.
Fig2 C-
lap.image
Of appendix
D-Fecolith
E-
E.vermicularis
On HPE
•
DISCUSSION:
1) Enterobius vermicularis is an extremely well adapted
parasite that usually produces no specific symptoms in
most colonized persons. Most symptoms are minor such
as pruritus ani and restless sleeping. People of every
socioeconomic group may acquire pinworm infection
and it remains quite prevalent.
2) The finding of E. vermicularis in appendectomy
histopathological specimens is a rare incident. Parasitic
infections rarely cause a clinical image of acute
appendicitis, especially in adults
3) No distinguishing symptoms were found caused by the
parasite which differentiated its presence in the
appendix from inflammation of that organ.
4) It seems probable that the presence of the parasites in
empty lumens may cause painful contractions of the
muscle wall which may simulate the symptoms of
appendicitis .
5) Although E. vermicularis may have a causal role in
appendiceal pain and chronic inflammation due to
obstructive phenomena, the overwhelming majority of
cases are not associated with acute inflammation.
Interestingly, the presence of pinworms in the appendix
may cause a clinical “appendiceal syndrome” even
without eliciting acute inflammation (Aydin 2007). This
“syndrome”, also mentioned as appendiceal colic,
consists of chronic right lower quadrant and pelvic pain,
intermittent in nature, and can be explained by the
hypothesis of appendiceal lumen obstruction. The
situation in acute appendicitis is less clear (Gialamas et
al. 2012).
CONCLUSION:
1.Surgeons should consider this differential
diagnosis especially when removing a
macroscopically non-inflamed appendix.
2.
REFERENCES
1.THE RELATIONSHIP BETWEEN OXYURIASIS AND APPENDICITIS- MARGARET
2.Live Taenia Worms in the Appendix: A Case Report-Open Access J Surg
Volume 6 Issue 1 - September 2017
3.Incidental parasitic infestations in surgically removed appendices: a
retrospective analysis-2007 Aydin; licensee BioMed Central Ltd.
4.Pin Worm Causing Acute Appendicitis: Case Report-Surgery Curr Res
Volume 6 • Issue 3 • ISSN
5. Enterobius Vermicularis infection of the appendix as a cause of acute
appendicitis in a Greek adolescent: a case report
6. Acute appendicitis secondary to Enterobius vermicularis infection in a
middle-aged man: a case report-2011
7. Enterobius vermicularis: A rare Cause of Appendicitis-2012 greece