An Unexpected Host

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The New England Journal of Medicine

A woman presented to the emergency department with intermittent abdominal pain and no other associated gastrointestinal symptoms. Examination showed thickening of the appendix and she was referred for a laparoscopic appendectomy. While the surgery was still going on, worms started crawling out of her appendix!

A 33-year-old woman reported to the emergency department with a complaint of intermittent pain on the right side of her lower abdomen. The pain was not associated with any other symptoms, such as, diarrhoea, vomiting or fever. Similarly, she had no recent history of travelling either.

Physical examination

Physical examination of the patient revealed tenderness in the right lower quadrant, suprapubic area and right flank of the abdomen. There was no guarding or rebound tenderness associated.

Further laboratory testing showed a leukocyte count of 15,000 per cubic millimeter (reference range, 4000 to 10,000), a neutrophil count of 13,000 per cubic millimeter (reference range, 2500 to 7000), and a normal eosinophil count. To confirm diagnosis, a CT scan of the abdomen was performed which showed thickening of the appendix with no signs of perforation or fecalith, a stone made of hardened feces of varying sizes. The hardened lumps of feces may occur anywhere in the intestinal tract but are more commonly found in the colon.

The patient was referred for a laparoscopic appendectomy.

During surgery, worms were seen emerging from the appendiceal stump

After removal of the appendix, worms were seen emerging from the appendiceal stump during surgery.

The worms were sent were histopathological analysis and identified as  Enterobius vermicularis. Infection with parasitic worm E. vermicularis commonly causes perianal pruiritis. The worms often migrate from the site of infection to the urinary and genital tract causing infections.

The patient was prescribed albendazole after surgery. She reported with no other complications or recurrence 1 year later at follow-up.

References

Julien, C., & Omouri, A. (2020). Parasite in the Appendix. New England Journal of Medicine383(11), e72.

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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