Parasitic Infestation of the Appendix, Masquerading as Acute Appendicitis

Abstract

Objectives: To evaluate the prevalence of parasitic infection in surgically removed appendices and investigate the role of parasitic infestation in the etiology of acute appendicitis.
Background:Enterobiusvermicularis is considered the most common helminth worldwide. Interestingly, the presence of parasite in the appendix may cause appendiceal colic even without eliciting an acute inflammatory reaction. The definitive diagnosis of parasitic infestation is generally achieved only after the histopathological examination of the resected appendix specimens.
Materials & Methods: A retrospective study over a span of 3 years included 593 pediatric and adolescent patients who underwent surgery for a diagnosis of acute appendicitis between January 2013 to December 2015. Microscopic slides of specimens which were histopathologically diagnosed to contain parasites were retrieved from the archives and reviewed for features of acute inflammation and parasite type. Patients were divided into 2 groups according to the presence or absence of the appendicitis.
Results: Total 593 appendectomies were performed in the PIMS hospital, of these 62(10.45%) were found to contain parasite on histopathology.This includes 24(38.71%) male and 38(61.29%) female patients. It was observed that 51 (82.25%) appendectomies were for acute appendicitis; however histopathological examination proved only worm infestation. Conclusion: Worm infestation without appendicitis is more frequent in children (64.52%) than adults (35.48%). Low prevalence of parasites among the appendectomy specimens did not support the notion that parasites were the major cause of appendicitis in children. Parasites rarely cause appendicitis but its symptoms resemble appendicitis. If we de-worm the children at school level on a regular basis we might prevent many future unnecessary appendectomies