ACUTE APPENDICITIS ASSOCIATED WITH ENTEROBIUS VERMICULARIS –CASE REPORT

Abstract

Enterobius vermicularis, typically found in cecum, appendix or terminal ileum, is the cause of the most common helminthic infestation in humans. A 19-year-old female patient, with normal laboratory results, was admitted for urgent appendectomy via McBurney inci-sion. After ligation and division of the inflamed appendixfrom the cecal basis, several viable and mobile enterobiusvermiculareswere identified. A short course of alben-dazole treatment was initiated and was interrupted on the second day as a result of the strong anaphylactic reaction. Contrast enhanced CT of the abdomen iden-tified infundibulum of the gallbladder filled with iregu-larhyperdense liquid indicative for parasitic infestation. One month later, elective laparoscopic cholecystectomywas performed, and the removed gallbladder was sentfor parasitological evaluation confirming non-viable worms. Infestation with Enterobius vermicularisobstructsthe lumen of the appendix, causing contraction of the wall and results in appendicitis-like symptoms without signs of acute inflammation. In minority of cases, with pure pathological signs of inflammation a finding of Eneterobius vermicularisis incidental. There are two possible hypotheses regarding the exact mechanism of gallbladder involvement: hematogenous spread or directmigration through unhealthy intestinal tissue. It is recommended to thoroughly examine all appendiceal specimens for presence of this worm, in order to provideadequate anthelminthic therapy in case of infestation.