Appendiceal syndrome associated with Enterobius vermicularis: a case report

Abstract

Background: Appendectomy is the most common emergency surgical procedure worldwide. The most widely accepted etiology is obstruction of the appendiceal lumen; however, parasitic etiology is uncommon. This report describes the case of a pediatric patient in whom active parasites compatible with Enterobius vermicularis were observed during transection of the cecal appendix.

Case description: A preoperative diagnosis of acute appendicitis was considered in a 2-year-old girl admitted to the Emergency Department for abdominal pain. On examination, muscle guarding and pain in the lower hemiabdomen were identified; the complete blood count showed leukocytosis. Laparoscopic surgery was performed, during which motile parasites compatible with E. vermicularis were found emerging from the appendiceal stump. The histopathological report confirmed the presence of E. vermicularis in the appendiceal lumen, without inflammatory involvement of the appendix.

Conclusions: Intraoperative visualization of motile parasites emerging from the appendiceal stump is unusual. In pediatric patients with abdominal pain and manifestations suggestive of acute appendicitis, it is important to obtain a more detailed medical and family history and to consider intestinal parasitosis as a relevant differential diagnosis in areas with deficient basic household sanitation and overcrowding.