Enterobius vermicularis infestation in appendectomies: A retrospective analytical study

Introduction: Gastrointestinal infection due to enterobius vermicularis is undoubtedly one of the most common human helminthic infections worldwide. It often causes acute appendicitis pain and is diagnosed only after histopathological examination of the resected appendix. Adult worms and their eggs are often found in resected appendices. Worldwide, the reported incidence of enterobius infestation in patients with symptoms of appendicitis ranges from 0.2–41.8%. Materials and Methods: This was a retrospective study conducted for a period of one year in the department of Pathology in a tertiary care hospital, GAIMS, G.K. General Hospital, Bhuj, Kutch in India. All the 151 surgically resected appendices submitted were included in the study. Out of these 151 appecdectomies, H&E stained sections of 15 cases were re evaluated due to the presence of parasite, enterobius vermicularis. Calculation of the modified Alvarado score was done and interpretation of the results was done according to published protocols. Results: 15 /151 cases (9.93%) were found to have the presence of enterobius vermicularis in the lumen of the appendix on histopathology. 6/15 (40%) cases that had the presence of acute inflammatory cells had a higher modified Alvarado score due to the presence of leucocytosis. 9/15 (60%) cases had the presence of abundant eosinophils in the wall of the appendix along with the presence of enterobius vermicularis. 6/15 (40%) cases that did not have the presence of acute inflammatory cells had a threshold or low score due to the absence of leucocytosis. Conclusion: Our study highlights the importance of histopathological examination of every resected specimen of appendix along with calculation of the modified Alvarado score in all cases of acute appendicitis, especially those having suspicious clinical findings suggestive of parasite infestation. Thus management of patients with parasites is different warranting antihelminthic medication.