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Pogorelić Z, Babić V, Bašković M, Ercegović V, Mrklić I. Management and Incidence of Enterobius vermicularis Infestation in Appendectomy Specimens: A Cross-Sectional Study of 6359 Appendectomies. J Clin Med 2024; 13:3198. [PMID: 38892909 PMCID: PMC11172809 DOI: 10.3390/jcm13113198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The role of Enterobius vermicularis infestation in the context of appendicitis is largely overlooked, but Enterobius vermicularis is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of Enterobius vermicularis findings in appendectomies and to evaluate the clinical and histopathologic features of patients with Enterobius vermicularis-associated acute appendicitis and those with appendiceal Enterobius vermicularis infestation. Methods: The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with Enterobius vermicularis on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. Results: The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with Enterobius vermicularis infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); p = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); p = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) p = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) p < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; p = 0.003) and less frequent vomiting (12.5% vs. 47.6%; p = 0.004) compared to the patients with Enterobius vermicularis-associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein (p = 0.009), White blood cells (p = 0.001) and neutrophils (p < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had Enterobius vermicularis infestation than in those with Enterobius vermicularis-related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); p = 0.040). Conclusions: Pediatric surgeons should consider Enterobius vermicularis infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict Enterobius vermicularis infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy.
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Affiliation(s)
- Zenon Pogorelić
- Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia
- Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Vlade Babić
- Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia
| | - Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vladimir Ercegović
- Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivana Mrklić
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, 21000 Split, Croatia
- Department of Pathology, School of Medicine, University of Split, 21000 Split, Croatia
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Ma Y, Liu Z, Ma W, Ma Y. The "Rescued" appendix. Asian J Surg 2024; 47:1791-1792. [PMID: 38148262 DOI: 10.1016/j.asjsur.2023.12.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023] Open
Affiliation(s)
- Yumei Ma
- Digestive Department of Qinghai Provincial People's Hospital, Xining, 810007, China
| | - Zhilan Liu
- Digestive Department of Qinghai Provincial People's Hospital, Xining, 810007, China
| | - Wende Ma
- Graduate School of Qinghai University, Xining, 810016, China; Menyuan County Medical Community, Menyuan County, 810300, China
| | - Yingcai Ma
- Digestive Department of Qinghai Provincial People's Hospital, Xining, 810007, China.
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Chhetri S, Al Mamari AH, Al Awfi MM, Al Khaldi NHN, Abed NM, Pandak N, Khamis F, Balushi ZA, Alalawi RMK, Al Lawati S, Ba'Omar M, Shukaili N, Al-Abri S. Enterobius vermicularis Related Acute Appendicitis: A Case Report and Review of the Literature. Infect Dis Rep 2023; 15:417-424. [PMID: 37489396 PMCID: PMC10366835 DOI: 10.3390/idr15040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
While the debate on the association between Enterobius vermicularis (E. vermicularis) and acute appendicitis has not been settled, a few case reports of this very rare encounter are beginning to come to light. E. vermicularis is one of the most common parasitic infections around the world, and acute appendicitis, on the other hand, is also a commonly encountered condition in general surgery. However, the association between these two conditions remains controversial. Here we present a case report of a young woman with appendicitis associated with E. vermicularis.
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Affiliation(s)
- Shabnam Chhetri
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
| | | | | | | | - Nibras Mejbel Abed
- Department of Colorectal Surgery, The Royal Hospital, Muscat, PC 111, Oman
| | - Nenad Pandak
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
| | - Faryal Khamis
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
| | | | | | - Sultan Al Lawati
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
| | - Muna Ba'Omar
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
| | - Nasser Shukaili
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
| | - Seif Al-Abri
- Department of Infectious Diseases, The Royal Hospital, Muscat, PC 111, Oman
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An Evaluation of the Efficacy of Systemic Immune-Inflammation Index in Predicting Enterobius-Associated Appendicitis Preoperatively. Cureus 2023; 15:e36733. [PMID: 36992816 PMCID: PMC10041780 DOI: 10.7759/cureus.36733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
Objective Our study aimed to retrospectively evaluate Enterobius-associated appendicitis cases and compare them with acute appendicitis cases in terms of parameters such as the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP)-to-lymphocyte ratio (CLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). We primarily aimed to evaluate the utility of SII in the differential diagnosis of Enterobius-associated appendicitis. Methods The appendectomy specimens of pediatric patients who were operated on for acute appendicitis between June 2016 and August 2022 were retrospectively evaluated. Enterobius-associated appendicitis cases were included for analysis. All patients were evaluated regarding age, gender, blood count, surgery, and pathology reports. Pathology reports were evaluated for the presence of histological signs of acute appendicitis. The patients were classified into an Enterobius-associated appendicitis group and a regular acute appendicitis group. CRP, white blood cell (WBC), red cell distribution width (RDW), neutrophils, lymphocytes, NLR, monocytes, eosinophils, platelet (PLT), PLR, CLR, and SII values were compared between the two groups. Results Eleven cases of Enterobius-associated appendicitis were identified out of 430 total cases (2.55%) examined. The mean age of the group with acute appendicitis was 12.83 ±3.16 years, while the mean age of the group with Enterobius-associated appendicitis was 8.55 ±2.54 years. There was no statistically significant difference in terms of CRP, WBC, RDW, lymphocytes, neutrophils, NLR, monocytes, eosinophils, PLT, PLR, and CLR values between the two groups (p>0.05). However, when the SII values of the participants were analyzed, it was observed that the SII values of the participants in the regular appendicitis group were significantly higher than those of the participants in the Enterobius group (p<0.05). Among the 11 Enterobius-associated appendicitis patients, seven appendectomy specimens revealed no inflammation and were regarded as negative appendectomy (63.63%). Conclusion This is the first study to demonstrate the utility of preoperative SII evaluation in Enterobius-associated appendicitis. SII is a simple, easy-to-calculate indicator of Enterobius-associated appendicitis and aids in the preoperative differential diagnosis of acute appendicitis.
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Enterobius Vermicularis Infection: A Cross-sectional Study in Preschool and School Children in the North-Western Part of Slovenia. Helminthologia 2022; 59:357-363. [PMID: 36875684 PMCID: PMC9979069 DOI: 10.2478/helm-2022-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2023] Open
Abstract
Enterobius vermicularis is a prevalent intestinal nematode. The objective of the research was to study enterobiasis prevalence in symptomatic children <15 years of age attending community health center in North - Western part of Slovenia in years 2017 - 2022. Perianal tape tests were performed on three consecutive days. The overall prevalence was 34.2 % (296 out of 864 children included). The mean age of children positive for E. vermicularis was 5.77 (95 % CI: 5.51 - 6.04) and 4.74 (95 % CI: 4.54 - 4.95), p<0.001 for children with negative test results. The positivity rate was not significantly different for boys compared to girls (boys 37.0 %, 95 % CI: 32.4 % - 41.8 %, girls 31.8 %, 95 % CI: 27.6 % - 36.2 %, p=0.107). The number of boys with all three samples positive in a sample set was higher compared to girls (p - value 0.002). Family size affected the positivity rate - the mean number of siblings was higher in positive children. Significant association with E. vermicularis infection was proven by the presence of anal pruritus and absence of abdominal discomfort. High E. vermicularis warrants careful monitoring of trends and public health response. It is necessary to encourage the use of hygiene measures in schools and empower parents to recognize enterobiasis timely.
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O'Brien S, Ahmed S, Hayes B, O'Riordain M. Large-bowel obstruction secondary to Enterobius vermicularis pseudotumour. BMJ Case Rep 2022; 15:e252676. [PMID: 36446475 PMCID: PMC9710356 DOI: 10.1136/bcr-2022-252676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Enterobius vermicularis infection is typically observed in paediatric patients and manifests with perianal pruritus, but other manifestations or ectopic presentations have been reported in the literature. We present the case of a man in his 60ss with a large-bowel obstruction with symptoms including a 4-day history of progressive abdominal pain, distension, vomiting and absolute constipation. On examination, his abdomen was distended with tinkling bowel sounds on auscultation. Cross-sectional imaging demonstrated an obstructing mass in the distal descending colon. An emergency laparoscopic Hartmann's procedure was performed and the patient made an uneventful recovery. An intraoperative colonoscopy demonstrated numerous white threadworms in the colon. Histological analysis demonstrated a pseudotumour related to Enterobius vermicularis infection. This case represents a rare differential diagnosis for a large-bowel obstruction.
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Affiliation(s)
- Stephen O'Brien
- Department of Surgery, Mercy University Hospital, Cork, Ireland
| | - Sami Ahmed
- Department of Surgery, Mercy University Hospital, Cork, Ireland
| | - Brian Hayes
- Department of Histopathology, Cork University Hospital, Cork, Ireland
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Sousa J, Hawkins R, Shenoy A, Petroze R, Mustafa M, Taylor J, Larson S, Islam S. Enterobius vermicularis-associated appendicitis: A 22-year case series and comprehensive review of the literature. J Pediatr Surg 2022; 57:1494-1498. [PMID: 34756582 DOI: 10.1016/j.jpedsurg.2021.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Enterobius vermicularis is known to be associated with appendicitis, however a causal relationship between Enterobius and appendicitis has not been established. The aim of this study was to explore the relationship between appendiceal Enterobius and histologic appendicitis. METHODS A retrospective review was performed of all pediatric appendectomies between 1997 and 2019. Patients with diagnosed with Enterobius were included for analysis. Patient demographics, operative findings, and pathologic reports were queried. Data were entered into an encrypted database and subsequently analyzed. A comprehensive review of the literature was also conducted. RESULTS Thirty-eight cases of Enterobius-associated appendicitis were identified out of 3541 (1.07%). Grossly normal appendices at operation were seen in 27% of patients. Inflammatory infiltrate was noted on histopathology in 78.3%, and Enterobius was considered to be the cause of that inflammation in 68.4%. The comprehensive literature review revealed 19 articles (1.87% incidence) that noted 35% of patients with appendiceal Enterobius had appendicitis on either histopathology or gross evaluation. CONCLUSION The high rate of inflammation on pathology found among our patients with pinworm appendicitis suggests an association with presentation as acute appendicitis. Our comprehensive review revealed a higher proportion of Enterobius appendicitis. Treatment with antihelminthic therapy is recommended. LEVEL OF EVIDENCE (LOE) Level IV(4)-case series and comprehensive review.
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Affiliation(s)
- John Sousa
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Russell Hawkins
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Archana Shenoy
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Robin Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Moiz Mustafa
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Janice Taylor
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Shawn Larson
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA.
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Hasan A, Nafie K, El-Sayed S, Nasr M, Abdulmohaymen A, Baheeg M, Abbadi O. Enterobius vermicularis in appendectomy specimens; Clinicopathological assessment: Cross sectional study. Ann Med Surg (Lond) 2020; 60:168-172. [PMID: 33149902 PMCID: PMC7599363 DOI: 10.1016/j.amsu.2020.10.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/25/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study identifies the incidence of appendiceal Enterobius vermicularis (E.v) infestation in all the patients undergoing appendectomy and evaluates the relationship between E. v infestation of the appendix and the acute appendicitis. METHOD ology: All the routinely examined appendectomy specimens received in the pathology laboratory of a referral hospital over a three year period of time were reviewed for the existence of E. v. These cases were evaluated for clinico-laboratory characterization. RESULTS Out of 1150 appendectomies for clinical acute appendicitis picture, 31 (2.7%) cases revealed E. v infestation. The age ranged from 6 to 42 years old but more than 80% of the E. v infected cases were children. Twenty four cases (77.4%) did not show any other appendiceal pathology, six cases showed lymphoid hyperplasia and only one case showed concomitant histological acute inflammatory process. CONCLUSION E. v infestation is an incidental finding during histopathology examination of appendectomy specimens for patients with clinical diagnosis of acute appendicitis, however there is no relation between the existence of E. v and occurrence of acute appendicitis which is the main indication for appendectomy, so further studies are recommended to reach out earlier diagnosis to eliminate the unnecessary surgical intervention. Also surgeons should consider E. v as a differential diagnosis when removing a normal looking appendix to take the necessary precautions for minimizing any chance of contamination and sending all the normal looking appendectomy specimens for histopathology examination.
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Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Laboratory & Blood Bank Department, Prince Mishari Bin Saud Hospital, Baljurashi, Saudi Arabia
| | - Khalid Nafie
- Laboratory & Blood Bank Department, Prince Mishari Bin Saud Hospital, Baljurashi, Saudi Arabia
| | - Samar El-Sayed
- Department of Parasitology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mohamed Nasr
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ayman Abdulmohaymen
- Department of Surgical Oncology Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Baheeg
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Osama Abbadi
- Department of Biochemistry, Faculty of Medicine, Omdurman Islamic University, Sudan
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The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis. PLoS One 2020; 15:e0232143. [PMID: 32324817 PMCID: PMC7179856 DOI: 10.1371/journal.pone.0232143] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/07/2020] [Indexed: 01/13/2023] Open
Abstract
Although the main cause of appendicitis is unclear, infection with Enterobius vermicularis is suggested as a neglected risk factor. Since, there is no comprehensive analysis to estimate the prevalence of E. vermicularis in appendicitis; therefore, we conducted a global-scale systematic review and meta-analysis study to estimate the prevalence of E. vermicularis infection in appendicitis cases. PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies published until 15 August 2019. Pooled prevalence of E. vermicularis infection was estimated using the random effects model. Data were classified based on the continents and countries. Moreover, subgroup analyses regarding the gender, the human development index (HDI), and income level of countries were also performed. Fifty-nine studies involving 103195 appendix tissue samples belonging to the individuals of appendicitis were included. The pooled prevalence of E. vermicularis infection was (4%, 95%CI, 2–6%), with the highest prevalence (8%, 95% CI: 0–36%) and lowest prevalence (2%, 95% CI: 1–4%) in Africa and Americas continents, respectively. With respect to countries, the lowest and highest prevalence rates were reported from Venezuela (<1%, 95% CI: 0–1%) and Nigeria (33%, 95% CI: 17–52%), respectively. Indeed, a higher prevalence was observed in females, as well as in countries with lower levels of income and HDI. Our findings indicate the relatively high burden of E. vermicularis infection in appendicitis cases. However, our findings suggest the great need for more epidemiological studies to depth understand overlaps between E. vermicularis infection and appendicitis in countries with lower HDI and income levels.
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Ball N, Newsom D. Needles in the haystack: Enterobius vermicularis in the appendix. J Paediatr Child Health 2019; 55:1501-1502. [PMID: 31364223 DOI: 10.1111/jpc.14564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Nicola Ball
- Department of Paediatrics, University of New South Wales Rural Clinical School, Albury, New South Wales, Australia
| | - David Newsom
- Department of Paediatrics, University of New South Wales Rural Clinical School, Albury, New South Wales, Australia.,Department of Paediatrics, Albury Wodonga Health, Albury, New South Wales, Australia
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Hammood ZD, Salih AM, Mohammed SH, Kakamad FH, Salih KM, Omar DA, Hassan MN, Sidiq SH, Mustafa MQ, Habibullah IJ, Usf DC, Al Obaidi AE. Enterobius vermicularis causing acute appendicitis, a case report with literature review. Int J Surg Case Rep 2019; 63:153-156. [PMID: 31586892 PMCID: PMC6796714 DOI: 10.1016/j.ijscr.2019.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022] Open
Abstract
Enterobius vermicularis is one of the commonest parasitic infestations worldwide. Its association with acute appendicitis remains controversial. It is very rarely encountered during appendectomy. In this report, a case of acute appendicitis caused by Enterobius vermicularis has been presented.
Introduction Enterobius vermicularis is one of the commonest parasitic infestations worldwide but its association with acute appendicitis remains controversial. It is very rarely encountered during appendectomy. The aim of this paper is to report a case of acute appendicitis caused by Enterobius vermicularis. A 23-year-old housewife presented with a right lower abdominal pain for the past 8 h. Clinical examination revealed right iliac fossa tenderness upon palpation and rebound tenderness upon release. The patient was diagnosed as a case of suspected acute appendicitis. The patient was anesthetized and intubated. Delivery of the vermiform appendix done through right grid iron incision. Intra operatively an inflamed appendix obstructed by Enterobius vermicularis was noted. Conclusion Enterobius vermicularis can habit the appendix and induce the signs and symptoms of A.A with or without actual histopathological acute appendicitis. The treatment of choice is surgical resection of the appendix.
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Affiliation(s)
| | - Abdulwahid M Salih
- Faculty of Medical Sciences, School of Medicine, Department Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq; Chara Laboratory, Shahedan Street, Kalar, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq; Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq.
| | | | - Diyar A Omar
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq; Erbil Polytechnic University, Shaqlawa Technical Institute, Erbil, Kurdistan, Iraq
| | - Marwan N Hassan
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shadi H Sidiq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Mohammed Q Mustafa
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq; Medical Analysis Department, Science Faculty, Ishik university, Erbil, Kurdistan, Iraq
| | | | - Drood C Usf
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Anmar E Al Obaidi
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
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Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki J, Suzuki S. Preoperative high C-reactive protein level is associated with an increased likelihood for conversion from laparoscopic to open appendectomy in patients with acute appendicitis. Clin Exp Gastroenterol 2019; 12:141-147. [PMID: 31114285 PMCID: PMC6497831 DOI: 10.2147/ceg.s196471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Laparoscopic appendectomy (LA) has been increasingly adopted for its advantages over the open appendectomy, but there are possibilities of conversion from laparoscopic to open appendectomy (CA) if the patients had complicated appendicitis concurrently, or when the extent of inflammation prohibits successful procedure. In this retrospective study, we aimed to clarify the preoperative predictors for CA. Patients and methods: From January 2010 to April 2016, medical records of 93 consecutive patients who underwent LA for suspected appendicitis were reviewed retrospectively. Factors evaluated were age, gender, body mass index, C-reactive protein (CRP), white cell count, albumin, Neutrophil count, lymphocyte count, Neutrophil/lymphocyte ratio, preoperative CT imaging (abscess formation: yes/no, appendicolith: yes/no), operative factors (time to operation, amount of bleeding), length of hospital stay, period until oral intake after surgery, and period from initial symptoms to surgery. Results: CA occurred in nine patients (9.7%). The reason for conversion was severe dense adhesion in two cases, inadequate exposure of appendix in two cases, uncompleted appendectomy in two cases, perforated appendicitis in one case, gangrenous appendicitis in one case, and abscess formation in one case. Based on 93 patients evaluated by preoperative CT scan, significant factors in the final multivariate analysis associated with CA was CRP [odds ratio=1.13, 95% CI:1.00–1.28, p=0.04]. Conclusion: Identifying the potential factors for conversion preoperatively may assist the surgeons in making decisions concerning the management of patients with appendicitis and in the judicious use of LA.
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Affiliation(s)
- Mitsugi Shimoda
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Tsunehiko Maruyama
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Kiyotaka Nishida
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Kazuomi Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Tomoya Tago
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Shuji Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan
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Wendt S, Trawinski H, Schubert S, C. Rodloff A, Mössner J, Lübbert C. The Diagnosis and Treatment of Pinworm Infection. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:213-219. [PMID: 31064642 PMCID: PMC6522669 DOI: 10.3238/arztebl.2019.0213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 10/29/2018] [Accepted: 02/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Symptomatic infection with pinworm (Enterobius vermicularis), a human pathogen, is clinically relevant in Germany, with an estimated prevalence in childhood of 2-20%. Enterobiasis can cause major mental distress. There is little systematically verified knowledge on the treatment of this condition, and there is no corresponding German guideline. This review is, therefore, intended as a summary of the current state of knowledge. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed for literature appearing from 1 January 1990 to 5 February 2019 and containing the search terms "enterobiasis," "oxyuriasis," "Enterobius vermicula- ris," "pinworm," and "threadworm." RESULTS More than one billion people worldwide are thought to be infected with pinworm. Estimates of its prevalence among kindergarten and primary-school pupils in Europe are generally near 20%. Infants (<2 years of age), adolescents (>14 years of age), and adults are only sporadically affected. The main risk factors are age 4-11 years, uncontrolled anus-finger-mouth contact, nail-biting (onychophagia/peri- onychophagia), unsupervised body hygiene, and poor compliance with basic hand hygiene. No large-scale, randomized, controlled trials of treatment are available. The approved antihelminthic agents are mebendazole, pyrantel embonate, and pyrvinium embonate (success rates up to >90%). For recurrent infections, prolonged treatment for up to 16 weeks (a "pulse scheme") is recommended. CONCLUSION In nearly all cases, antihelminthic treatment along with attention to hygienic measures can successfully eradicate pinworm infection and prevent recurrence and autoinfection. The involvement of all persons living in the patient's house- hold, including sexual partners, is a prerequisite to the lasting success of treatment.
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Affiliation(s)
- Sebastian Wendt
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital
- Interdisciplinary Centre for Infectious Diseases (ZINF), Leipzig University Hospital
| | - Henning Trawinski
- Interdisciplinary Centre for Infectious Diseases (ZINF), Leipzig University Hospital
- Department of Gastroenterology, Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital
| | - Stefan Schubert
- Interdisciplinary Centre for Infectious Diseases (ZINF), Leipzig University Hospital
- Department of Gastroenterology, Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital
| | - Arne C. Rodloff
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital
- Interdisciplinary Centre for Infectious Diseases (ZINF), Leipzig University Hospital
| | | | - Christoph Lübbert
- Interdisciplinary Centre for Infectious Diseases (ZINF), Leipzig University Hospital
- Department of Gastroenterology, Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital
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Sosin M, Kent JR, Chahine AA. Enterobius vermicularis Appendiceal Colic. J Laparoendosc Adv Surg Tech A 2019; 29:717-719. [PMID: 30720386 DOI: 10.1089/lap.2018.0693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Enterobius vermicularis associated appendiceal colic and acute appendicitis are rarely encountered in the United States. The 9-year-old patient described in this case presented with right lower quadrant abdominal pain, nausea, and vomiting consistent with acute appendicitis and was brought to the operating room for an appendectomy. Intraoperatively a pinworm, E. vermicularis, was visualized and the presumptive diagnosis of acute appendicitis was revised to E. vermicularis associated appendiceal colic. Retrospective review of the preoperative imaging demonstrates the first reported ultrasonographic image of pinworm inhabitance within the appendiceal lumen. The patient was treated postoperatively with a course of albendazole and recovered appropriately. This article reviews the geographic epidemiology, pathophysiology, surgical, and medical treatment recommendations in the management of E. vermicularis diseases of the appendix. Through dissemination of this ultrasonographic imaging, the authors hope to inform other providers about E. vermicularis associated appendiceal colic and reduce the incidence of avoidable surgeries.
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Affiliation(s)
- Michael Sosin
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Johnathan R Kent
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - A Alfred Chahine
- Division of Pediatric Surgery, Children's National Health System, Washington, District of Columbia
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Friesen J, Bergmann C, Neuber R, Fuhrmann J, Wenzel T, Durst A, Müller M, Ignatius R. Detection of Enterobius vermicularis in greater Berlin, 2007-2017: seasonality and increased frequency of detection. Eur J Clin Microbiol Infect Dis 2019; 38:719-723. [PMID: 30712227 DOI: 10.1007/s10096-019-03495-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/22/2019] [Indexed: 11/30/2022]
Abstract
The pinworm (Enterobius vermicularis) causes mostly mild infections characterised by nocturnal anal pruritus, mainly in children. Still, the infection is stigmatising and sleep disturbances may lead to lack of concentration. For Germany, no epidemiological data are available. Laboratory data of all patients for whom detection of E. vermicularis by cellulose tape test had been requested between 2007 and November 2017 were analysed retrospectively. E. vermicularis was detected in 971/5578 (17.4%) samples collected from 3991 patients. The detection rate increased significantly within the period of investigation. It was higher in male than in female patients (20.0 vs. 15.4%). Children 4 to 10 years old and, if also examined, their relatives were most frequently affected. Control investigations at an interval of at least 1 month, which could indicate insufficient therapy or re-infection, were performed in 90/714 patients (12.6%). While parasite detection in children < 6 years was evenly distributed throughout the year, in older patients, it peaked between October and December. In conclusion, in the area of investigation, the frequency of E. vermicularis is higher in males than in females and is subject to a hitherto undescribed seasonality. The causes of the increased frequency of parasite detection warrant further investigations.
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Affiliation(s)
| | - Clara Bergmann
- Department of Microbiology and Infection Immunology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Robert Neuber
- MVZ Labor 28, Mecklenburgische Str. 28, 14197, Berlin, Germany
| | - Jörg Fuhrmann
- MVZ Labor 28, Mecklenburgische Str. 28, 14197, Berlin, Germany
| | - Thilo Wenzel
- MVZ Labor 28, Mecklenburgische Str. 28, 14197, Berlin, Germany
| | - Anita Durst
- MVZ Labor 28, Mecklenburgische Str. 28, 14197, Berlin, Germany
| | - Michael Müller
- MVZ Labor 28, Mecklenburgische Str. 28, 14197, Berlin, Germany
| | - Ralf Ignatius
- MVZ Labor 28, Mecklenburgische Str. 28, 14197, Berlin, Germany. .,Department of Microbiology and Infection Immunology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Alejandre Villalobos C, Fernández-SanMillán D, López-Tomassetti Fernández E, Hernández Hernández JR. Apendicitis aguda por parasitosis. Cir Esp 2018; 96:306-308. [DOI: 10.1016/j.ciresp.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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Amer AS, Saad AE, Antonios SN, Hasby EA. Prevalence of Parasitic Infections in Surgically Removed Appendices: Parasitological and Histopathological Studies. Helminthologia 2018; 55:33-44. [PMID: 31662625 PMCID: PMC6799533 DOI: 10.1515/helm-2017-0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/15/2017] [Indexed: 02/05/2023] Open
Abstract
Intestinal parasites may cause symptoms similar to acute appendicitis. Moreover, the diagnosis of parasitic infections is only done by post-operative histopathological examination of the appendices. Therefore, our aims are to assess the prevalence of intestinal parasitic infections among patients who were be appendectomized at Tanta Hospitals, Egypt and to investigate the possible association between these parasitic infections and appendicitis. To achieve these objectives, we performed a cross-sectional study including 65 patients chosen randomly who had undergone appendectomy over a period of one year from Oct 2015 to Oct 2016. Demographic data were retrieved. Complete blood picture was done. Moreover, appendiceal faecolith were examined macroscopically then by direct smear examination, formol-ether concentration technique, modified Ziehl-Nelseen stain and rapid immunochromatographic test. Histopathological examination of resected appendices was done. We found that parasitic infections were detected in 24.6 % of examined cases. Most of parasitic infections were prevalent in patients belonging to the school age group. Different parasitic infections were detected in the faecolith specimens. Moreover, Enterobious vermicularis adult female and Schistosoma mansoni granuloma were detected in histopathological sections. Also, a spectrum of pathological changes in the appendices was found ranging from lymphoid hyperplasia to acute inflammation with peritonitis. In conclusion, intestinal parasites may cause clinical picture similar to that of acute appendicitis. Therefore, careful attention to clinical history, stool examination and high eosinophilia may aid diagnosis and avoid unnecessary appendectomy. Moreover, the presence of different parasitic stages in the narrow lumen of the appendix may have a role in the development of appendicitis and this needs further studies.
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Affiliation(s)
- A. S. Amer
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - A. E. Saad
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - S. N. Antonios
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - E. A. Hasby
- Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Isolated Appendiceal Pinworms on Colonoscopy. J Pediatr Gastroenterol Nutr 2017; 64:e155. [PMID: 28045771 DOI: 10.1097/mpg.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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