ABSTRACT

Objective:

Enterobius vermicularis is a common gastrointestinal parasite. Acute appendicitis is one of the most common clinical conditions requiring surgical intervention. The coexistence of enterobiasis and acute appendicitis has attracted the attention of researchers for a long time. In this article, it is aimed to present the characteristics of enterobiasis cases detected in appendectomy specimens in a tertiary healthcare institution. In addition, it is aimed to reveal the differences by comparing the cases diagnosed with acute appendicitis without enterobiasis.

Methods:

All cases operated for acute appendicitis between January 1, 2008 and December 31, 2021 were retrospectively evaluated through the hospital registry system. The cases with histopathologically determined E. vermicularis were reviewed and a study group was formed. The control group consisted of patients diagnosed with acute appendicitis for reasons other than enterobiasis, matched with the study group in terms of age and gender. Complete blood count, C-reactive protein (CRP) ultrasonography evaluations were compared between the two groups.

Results:

During the study period, 3.650 appendectomy materials were examined; E. vermicularis was detected in 1.32% (n=48) cases, and acute appendicitis was present in 33.33% (n=16) of the cases. Lymphoid hyperplasia was the most common histopathological change in the study group (n=25; 52.08%). When compared to the control group, leukocyte, neutrophil, CRP, ultrasonographic appendix diameter values were found to be significantly higher in the control group, and the percentage of eosinophils in the study group (p<0.0001; p<0.0001; p<0.0001; p<0.0001; p=0.001; respectively).

Conclusion:

Enterobiasis is a common parasite especially in children. Rarely, it can be seen in patients with acute appendicitis. Histopathological evaluation is necessary to ensure a safe surgical procedure and to complete the treatment with anthelmintic drugs. Enterobiasis should be kept in mind in cases when the acute phase response is lower than expected.

Keywords: Enterobius vermicularis, acute appendicitis, lymphoid hyperplasia

References

Centers for Disease Control and Prevention.Enterobiasis (Enterobius vermicularis) from laboratory identification of parasites of public health concern: Centers for Disease Control and Prevention; 2009 Available from: URL: https://www.cdc.gov/dpdx/enterobiasis/ index.html

Juckett G. Common intestinal helminths. Am Fam Physician. 1995; 52: 2039-48, 2051-2.

Türkiye Çocuk Cerrahisi Derneği. Çocuklarda Apandisit ve Ayrıcı Tanısı. Ege Üniversitesi Rektörlüğü Basımevi, İzmir, 2018.

Budd JS, Armstrong C. Role of Enterobius vermicularis in the aetiology of appendicitis. Br J Surg 1987; 74: 748-9.

Dunn James J Y: Appendicitis. In Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger RC, Caldamone AA, editors. Pediatric Surgery. Elsevier Saunders, Philadelphia, 2012. p: 1255-78.

Sinniah B, Leopairut J, Neafie RC, Connor DH, Voge M. Enterobiasis: a histopathological study of 259 patients. Ann Trop Med Parasitol 1991; 85: 625-35.

Gialamas E, Papavramidis T, Michalopoulos N, Karayannopoulou G, Cheva A, Vasilaki O, et al. Enterobius vermicularis: a rare cause of appendicitis. Turkiye Parazitol Derg 2012; 36: 37-40.

Sousa J, Hawkins R, Shenoy A, Petroze R, Mustafa M, Taylor J, et al. Enterobius vermicularis-associated appendicitis: A 22-year case series and comprehensive review of the literature. J Pediatr Surg 2022; 57: 1494-8.

Cook GC. Parasitic Disease in Clinical Practice, Springer-Verlag, London, 1990, pp. 114e116.

Ariyarathenam AV, Nachimuthu S, Tang TY, Courtney ED, Harris SA, Harris AM. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg 2010; 8: 466-9.

Maloney C, Edelman MC, Bolognese AC, Lipskar AM, Rich BS. The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate. J Pediatr Surg 2019; 54: 1794-9.

Zouari M, Louati H, Abid I, Trabelsi F, Ben Dhaou M, Jallouli M, et al. Enterobius vermicularis: A Cause of Abdominal Pain Mimicking Acute Appendicitis in Children. A Retrospective Cohort Study. Arch Iran Med 2018; 21: 67-72.

Gorter RR, van Amstel P, van der Lee JH, van der Voorn P, Bakx R, Heij HA. Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results from a cohort study. J Pediatr Surg 2017; 52: 1269-72.

Yabanoğlu H, Aytaç HÖ, Türk E, Karagülle E, Calışkan K, Belli S, et al. Parasitic infections of the appendix as a cause of appendectomy in adult patients. Turkiye Parazitol Derg 2014; 38: 12-6.

Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health 2007; 38: 20-3.

Hasan A, Nafie K, El-Sayed S, Nasr M, Abdulmohaymen A, Baheeg M, et al. Enterobius vermicularis in appendectomy specimens; Clinicopathological assessment: Cross sectional study. Ann Med Surg (Lond) 2020; 60: 168-72.

Fleming CA, Kearney DE, Moriarty P, Redmond HP, Andrews EJ. An evaluation of the relationship between Enterobius vermicularis infestation and acute appendicitis in a paediatric population--A retrospective cohort study. Int J Surg 2015; 18: 154-8.

Pehlivanoğlu B, Aydın Türk B, İşler S, Özdaş S, Abeş M. Findings in Appendectomies with Enterobius vermicularis Infection: Pinworm Is Not A Cause of Appendicitis. Turkiye Parazitol Derg 2019; 43: 21-5.

Smith TA. Lymphoid hyperplasia of the appendix in children; its relation to recurrent appendicitis. Ann Surg 1924; 79: 871-8.

Kooij IA, Sahami S, Meijer SL, Buskens CJ, Te Velde AA. The immunology of the vermiform appendix: a review of the literature. Clin Exp Immunol 2016; 186: 1-9.

Lamps LW. Infectious causes of appendicitis. Infect Dis Clin North Am. 2010; 24: 995-1018, ix-x.

Akkapulu N, Abdullazade S. Is Enterobius vermicularis infestation associated with acute appendicitis? Eur J Trauma Emerg Surg 2016; 42: 465-70.

Sodergren MH, Jethwa P, Wilkinson S, Kerwat R. Presenting features of Enterobius vermicularis in the vermiform appendix. Scand J Gastroenterol 2009; 44: 457-61.

Clinicopathological Assesment in Patients with Enterobius vermicularis Infection

ABSTRACT

References