Worm in vermiform appendix: a surgeon's perspective.

To cite: Naalla R, S, ShettyP, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014205411 DESCRIPTION A 23-year-old man presented to us with reports of right-sided lower abdominal pain for 1 day associated with anorexia and nausea. Abdominal ultrasound scan showed inflammed appendix. His routine blood investigations revealed mild neutrophilic leucocytosis and eosinophilia. He was taken up for emergency laparoscopic appendicectomy. Intraoperatively, after dividing the appendix between the endoloop ligatures three pinworms (Entrobious vermicularis) fell into the abdomen. One of them reached the abdominal wall (figure 1), and its movement can be seen (video 1). All three of them were extracted using blunt grasper. Appendix specimen was cut open and we found one more pinworm in it (figure 2). He was prescribed albendazole 400 mg/week for two doses. The patient is asymptomatic after 2 months of follow-up. Entrobius vermicularis is the most common helminthic infection, it is most frequently observed in children aged 5–10 years. Humans are the only natural host. The lifecycle begins when the gravid female deposits eggs in the perianal area. Following ingestion, eggs are hatched and larvae are produced in the small intestine. However, caecum and appendix are usual sites of infestation. Usually pinworm infections are symptomatic with the most common symptom being perianal itching. Occasionally symptoms like nausea, abdominal pain or diarrhoea may be present. Incidence of pinworms in patients with symptoms of appendicitis is 0.2–41.8% but appendiceal infestation itself is the cause of appendicitis which is still under debate. Pinworms may obstruct the lumen of appendix, or they may elicit hypersensitivity reaction in the tissues causing clinical picture