Appendiceal Enterobius vermicularis Mimicking Acute Appendicitis in an 8-Year-Old Girl - Consultant360

AUTHORS:
Caitlin Porter-Smith, BA, BS
Fourth-Year Medical Student, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado

Saundra Kay, MD
Rocky Mountain Pediatric Surgery and Rocky Mountain Hospital for Children at Presbyterian/St. Luke's, Denver, Colorado

Dehua Wang, MD
Pediatric Pathology, Rocky Mountain Hospital for Children at Presbyterian/St. Luke's, Denver, Colorado

Pisespong Patamasucan, MD
Pediatric Infectious Disease, Rocky Mountain Hospital for Children at Presbyterian/St. Luke's, Denver, Colorado

CITATION:
Porter-Smith C, Kay S, Wang D, Patamasucan P. Appendiceal Enterobius vermicularis mimicking acute appendicitis in an 8-year-old girl [published online January 22, 2020]. Infectious Diseases Consultant.

An 8-year-old previously healthy girl presented with a 36-hour history of waxing and waning abdominal pain with associated nausea. The pain had begun in the middle of the night, was localized just below the umbilicus, and worsened with movement. The child's maximum temperature, recorded at home, had been 37.6°C. There had been no vomiting, diarrhea, or anorexia.

The patient had been evaluated at an urgent care center, where results of urinalysis and abdominal ultrasonography were normal, although the appendix had not been not visualized in its entirety. Findings of further review of systems were noncontributory. Constipation was suspected, given that the patient had not had a bowel movement in the past 2 days.

The girl had felt a little better the next morning, but the pain worsened during the day, and she presented to our center for further evaluation of severe abdominal pain by midday.

On physical examination, she appeared well. The abdomen was soft and nondistended, with tenderness on deep palpitation of the periumbilical region and right lower quadrant but no guarding. In-office ultrasonography revealed a mildly enlarged, hyperemic appendiceal tip with a small volume of surrounding free fluid and inflammation, concerning for early appendicitis.

A laparoscopic appendectomy was performed. While dividing the appendix between endoloops, the surgeon noted tiny white worms (Figure 1). These were immediately suctioned up, and a few worms were sent for pathology testing along with the appendix. Enterobius vermicularis was later confirmed in the appendix (Figures 2 and 3).

Figure 1. Intraoperative image with white worms visible while dividing the appendix between endoloops.

Figure 2. Histological cross-section of E vermicularis within the lumen of the appendix (hematoxylin-eosin, original magnification ×100).

Figure 3. Histological longitudinal section of E vermicularis isolated during laparoscopic appendectomy (hematoxylin-eosin, original magnification ×100).

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