IMAGES IN MEDICINE
Enterobius infestation in suspected appendicitis
Department of Surgery, Birmingham Heartlands Hospital, Birmingham, UK
Correspondence to:
Dr A Harris, Department of Surgery, Birmingham Heartlands Hospital, Birmingham, UK; a.harris@doctors.org.uk
| The first 150 words of the full text of this article appear below. |
A 16-year-old woman presented with symptoms and signs suggesting appendicitis.
At laparoscopy, the appendix was mildly inflamed and was excised. Multiple small, medusa-like projections were seen at the appendix stump (fig 1), suggesting worm infestation. A decision was made to ablate using diathermy, as they were technically difficult to capture, risking intraperitoneal contamination with unknown consequences.
Figure 1 Medusa-like projections seen at the appendix stump.
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The patient made an uneventful postoperative recovery, and after histological confirmation of Enterobius vermicularis infestation, in the presence of acute inflammation, was started on anti-helminth treatment (mebendazole 100 mg orally twice daily for 3 days).
E vermicularis infection is seen in up to 4% of appendicectomy specimens. Although infestation may be related to pain, it is seldom seen in the presence of an acute appendicitis. It is believed that, rather than causing inflammation, the worms migrate away from an inflamed appendix.1 In this case, the
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