Concomitant ectopic Enterobius vermicularis infection in uterine cervical cancer.

BACKGROUND: Enterobius vermicularis (E. vermicularis), also referred to as pinworm, is a widespread human intestinal parasite which predominantly occurs in young children, making their caretakers a population at risk for the transmission of this helminth. It can occasionally affect extraintestinal organs and tissues, including the female genital tract. Infestation can be asymptomatic or manifest as different kinds of gynaecological disorders, such as pelvic inflammation mimicking tumours, abnormal uterine bleeding, or vaginitis. Diagnosis is made by identifying ova in the sample collected from the perineal skin using a transparent adhesive tape or microscopic examination of resected tissue. Mebendazole is the first-line medication and should also be administered to all household members. CASE PRESENTATION: We present a case of a patient who had undergone surgery for invasive cervical cancer with an accidental finding of E. vermicularis eggs in the cervix. CONCLUSIONS: Although not very common, infestation with E. vermicularis should be considered in differential diagnoses of various gynaecological disorders accompanied by histological findings of granulomatous inflammation.

Transverse Myelitis in the Setting of Enterobius vermicularis (Pinworm) Infection: Case Report.

Myelitis is a rare inflammatory myelopathy, and known associated etiologies only account for a small number of causes. A significant percentage of cases have an unknown etiology and are considered idiopathic. With 64% to 68% of cases fitting into the idiopathic category, helminth infections, and specifically pinworm parainfections, should be considered in cases that would otherwise be classified as idiopathic. This case report outlines a pediatric patient diagnosed with myelitis given her progressive weakness, fussiness, refusal to bear weight as well as magnetic resonance imaging (MRI) demonstrating T2-hyperintense signal and/or T1 gadolinium enhancement, and/or positive cerebrospinal fluid (CSF) inflammatory markers. This patient had a negative evaluation for typical known etiologies for myelitis including no signs of multiple sclerosis and neuromyelitis optica spectrum disorder on brain MRI, oligoclonal banding and aquaporin-4 autoantibodies, and no evidence of bacterial or viral meningitis given normal cell counts and cultures in CSF. She was found to have a pinworm infection, suggesting a parasitic parainfectious etiology of her myelitis. This case outlines the first case noting the correlation between myelitis and pinworm infection in a pediatric patient.

[Multilocular hepatic masses due to Enterobius vermicularis]. / Multilokuläre hepatische Raumforderungen durch Enterobius vermicularis.

Infestation with Enterobius vermicularis involving extraintestinal manifestation is rare. In a 50-year-old man with lower abdominal pain, computed tomography led to a suspected diagnosis of sigmoid carcinoma with liver metastasis. After ruling out colon cancer by endoscopy, laparoscopic resection of one suspected tumor nodule in the liver was performed. Histopathological examination revealed parasitic granulomas containing pinworms. Hematogenous migration was postulated in the setting of phlebitis with thrombosis of the inferior mesenteric vein.

Detection of Enterobius vermicularis in archived formalin-fixed paraffin-embedded (FFPE) appendectomy blocks: It's potential to compare genetic variations based on mitochondrial DNA (cox1) gene.

Acute appendicitis represents one of the most common causes of emergency abdominal surgery worldwide. Meanwhile, Enterobius vermicularis has been suggested as one of the probable causes of appendicitis. In this study, the morphological characteristics of the remnant pinworms and pathologic changes were explored in old-archived FFPE tissues of appendectomies. Moreover, we provide the first molecular identification, genetic, and haplotype variation of this nematode from the old-archived FFPE tissue section of appendectomy using the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Seventeen FFPE appendectomies with E. vermicularis infection, stored over 12-22 years, were collected from two different geographical areas of Iran. In the histopathological examination, tissue changes were observed in thirteen cases (76.4%) and inflammation in four blocks (23.5%). After DNA extraction, the cox1 gene was amplified in twelve (70.6%) cases using the nested polymerase chain reaction (PCR). Phylogenetic analysis and a median-joining network of 78 available cox1 sequences of E. vermicularis revealed 59 haplotypes. We identified five haplotypes that fell into type B. All Haplotypes are novel except for two haplotypes, Hap32 and Hap37, identical to E. vermicularis sequences from Iran, Greece, and Germany. The ranges of diversity distance and haplotype diversity within the isolates were 0-1.9% and HD:0.643-0.667, subsequently. Overall, the absence of inflammation or even tissue changes in some sections can suggest the possible non-inflammatory role of E. vermicularis in appendicitis. Although FFPE material suffers from PCR inhibition, we could successfully use nested PCR to characterize E. vermicularis in old-archived appendectomy blocks and suggest this method as a complementary diagnosis technique in pathology. While the predominant type was B in the Middle East and Europe, further studies on a larger sample size from different geographical regions could probably confirm the results obtained in the present study.

Large-bowel obstruction secondary to Enterobius vermicularis pseudotumour.

Enterobius vermicularis infection is typically observed in paediatric patients and manifests with perianal pruritus, but other manifestations or ectopic presentations have been reported in the literature. We present the case of a man in his 60ss with a large-bowel obstruction with symptoms including a 4-day history of progressive abdominal pain, distension, vomiting and absolute constipation. On examination, his abdomen was distended with tinkling bowel sounds on auscultation. Cross-sectional imaging demonstrated an obstructing mass in the distal descending colon. An emergency laparoscopic Hartmann's procedure was performed and the patient made an uneventful recovery. An intraoperative colonoscopy demonstrated numerous white threadworms in the colon. Histological analysis demonstrated a pseudotumour related to Enterobius vermicularis infection. This case represents a rare differential diagnosis for a large-bowel obstruction.

Prevalencia de enterobiasis y factores socioambientales en una zona rural de Ecuador / Prevalence of enterobiasis and socio-environmental factors in a rural area from Ecuador

La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)

Intramural Ova of Enterobius vermicularis in the Appendix-An Egg-Topic Location!

We report an unusual case of appendicitis in a 9-year-old girl in whom the wall of the appendix contained necrotizing granulomas, as well as eggs of Enterobius vermicularis. Although luminal E vermicularis adult parasites are commonly identified in the appendix and luminal eggs are occasionally seen, intramural worms and eggs are rare. We are unaware of earlier reports of ectopic intramural eggs in the appendix. It is important to and make a correct diagnosis, as both, the patient, as well as the family should be treated for enterobiasis.

Enterobius vermicularis-associated appendicitis: A 22-year case series and comprehensive review of the literature.

INTRODUCTION: Enterobius vermicularis is known to be associated with appendicitis, however a causal relationship between Enterobius and appendicitis has not been established. The aim of this study was to explore the relationship between appendiceal Enterobius and histologic appendicitis. METHODS: A retrospective review was performed of all pediatric appendectomies between 1997 and 2019. Patients with diagnosed with Enterobius were included for analysis. Patient demographics, operative findings, and pathologic reports were queried. Data were entered into an encrypted database and subsequently analyzed. A comprehensive review of the literature was also conducted. RESULTS: Thirty-eight cases of Enterobius-associated appendicitis were identified out of 3541 (1.07%). Grossly normal appendices at operation were seen in 27% of patients. Inflammatory infiltrate was noted on histopathology in 78.3%, and Enterobius was considered to be the cause of that inflammation in 68.4%. The comprehensive literature review revealed 19 articles (1.87% incidence) that noted 35% of patients with appendiceal Enterobius had appendicitis on either histopathology or gross evaluation. CONCLUSION: The high rate of inflammation on pathology found among our patients with pinworm appendicitis suggests an association with presentation as acute appendicitis. Our comprehensive review revealed a higher proportion of Enterobius appendicitis. Treatment with antihelminthic therapy is recommended. LEVEL OF EVIDENCE (LOE): Level IV(4)-case series and comprehensive review.

Bruxismo y desagaste oclusal asociado a enterobiasis en niños en edad preescolar de la provincia Junín / Bruxism and occlusal wear associated with enterobiasis in preschool children from Junín province

Debido a que el bruxismo es un hábito oral prevalente entre los niños y un potencial destructor de los tejidos orales, el presente estudio tuvo como objetivo investigar la relación entre las infecciones por Enterobius vermicularis y el bruxismo entre los niños de un preescolar en la provincia de Junin. La muestra estuvo conformoda por 96 niños de 4 a 6 años. El bruxismo se investigó en base a los informes de los padres sobre el rechinar de dientes por la noche, la calidad del sueño y aspectos clínicos tanto intraorales como extraorales relacionados con la afección. El análisis de datos involucró estadísticas descriptivas, chi-cuadrado de Pearson. La prevalencia de bruxismo fue de 65,62%. Se observó a través del índice de BEWE en los infantes con bruxismo y parasitados por E. vermicularis que el 30,15% se diagnóstico defecto evidente con pérdida de tejido duro menor. No se evidenció asociación estadísticamente significativa entre el bruxismo y el parsitismo por E. vermicularis. Con base en los presentes hallazgos, la prevalencia del bruxismo del sueño fue significativo(AU)

Because bruxism is a prevalent oral habit among children and a potential destroyer of oral tissues, the present study aimed to investigate the relationship between Enterobius vermicularis infections and bruxism among children of a preschool in the province of Junin. The sample consisted of 96 children from 4 to 6 years old. Bruxism was investigated based on parental reports of nighttime teeth grinding, sleep quality, and both intraoral and extraoral clinical aspects related to the condition. Data analysis involved descriptive statistics, Pearson's chi-square. The prevalence of bruxism was 65.62%. It was observed through the BEWE index in infants with bruxism and parasitized by E. vermicularis that 30.15% were diagnosed with an obvious defect with minor hard tissue loss. No statistically significant association was found between bruxism and E. vermicularis parasitism. Based on the present findings, the prevalence of sleep bruxism was significant(AU)

Pinworm infection in school children of four districts of Malakand region, Khyber Pakhtunkhwa, Pakistan / Infecção por Pinworm em crianças em idade escolar de quatro distritos da região de Malakand, Khyber Pakhtunkhwa, Paquistão

Illnesses caused by human pinworm remains a pediatric health problem in developing nations including Pakistan. This study aimed to investigate the prevalence of Enterobius vermicularis in school children of four districts in Malakand region, Pakistan. Four hundred faecal specimens were screened from May 2014 to July 2017 using normal saline and Lugol Iodine solution. Twenty three (5.75%) individuals were found infected with E. vermicularis. Five children (1.25%) were infected with only E. vermicularis and eighteen (4.5%) were mixed with other helminths. E. vermicularis 23 (5.75%), hookworm 11 (2.75%), Ascaris lumbricoides 5 (1.25%), Taenia saginata 2 (0.5%) and Trichuris trichuira 4 (1%) were detected. Age wise 5-8 years were more parasitized followed by 13-15 and 9-12 years of age (0.0296, P<0.05). Male children were highly (0.06700, P<0.05) infected than female. Children in Malakand district were found more infected followed by Dir Upper, similar infection rate was noted in children of districts Lower Dir and Swat (0.0192, P<0.05). Children in primary level were highly (0.0013, P<0.05) infected than those of middle and high levels. Enterobiosis is still the most common parasitic diseases in children. Studies on enterobiosis should be conducted time by time to recognize the hazardous of such parasitic infection in remote areas of the country.

As doenças causadas pela traça humana continuam sendo um problema de saúde pediátrica nos países em desenvolvimento, incluindo o Paquistão. Este estudo teve como objetivo investigar a prevalência de Enterobius vermicularis em escolares de quatro distritos na região de Malakand, Paquistão. Quatrocentos espécimes fecais foram selecionados de maio de 2014 a julho de 2017, usando solução salina normal e solução de lugol iodo. Vinte e três (5,75%) indivíduos foram encontrados infectados por E. vermicularis. Cinco crianças (1,25%) foram infectadas apenas com E. vermicularis e dezoito (4,5%) foram misturadas com outros helmintos. Foram detectados E. vermicularis 23 (5,75%), ancilóstomo 11 (2,75%), Ascaris lumbricoides 5 (1,25%), Taenia saginata 2 (0,5%) e Trichuris trichuira 4 (1%). Com relação à idade, 5-8 anos foram mais parasitados, seguidos por 13-15 e 9-12 anos de idade (0,0296, P <0,05). Crianças do sexo masculino foram altamente (0,06700, P <0,05) infectadas do que as do sexo feminino. As crianças no distrito de Malakand foram encontradas mais infectadas, seguidas por Dir Upper, taxa de infecção semelhante foi observada em crianças dos distritos Lower Dir e Swat (0,0192, P <0,05). As crianças do nível primário foram altamente (0,0013, P <0,05) infectadas do que as dos níveis médio e alto. A enterobiose ainda é a doença parasitária mais comum em crianças. Os estudos sobre enterobiose devem ser conduzidos periodicamente para reconhecer a periculosidade dessa infecção parasitária em áreas remotas do país.

Pinworm infection in school children of four districts of Malakand region, Khyber Pakhtunkhwa, Pakistan / Infecção por Pinworm em crianças em idade escolar de quatro distritos da região de Malakand, Khyber Pakhtunkhwa, Paquistão

Illnesses caused by human pinworm remains a pediatric health problem in developing nations including Pakistan. This study aimed to investigate the prevalence of Enterobius vermicularis in school children of four districts in Malakand region, Pakistan. Four hundred faecal specimens were screened from May 2014 to July 2017 using normal saline and Lugol Iodine solution. Twenty three (5.75%) individuals were found infected with E. vermicularis. Five children (1.25%) were infected with only E. vermicularis and eighteen (4.5%) were mixed with other helminths. E. vermicularis 23 (5.75%), hookworm 11 (2.75%), Ascaris lumbricoides 5 (1.25%), Taenia saginata 2 (0.5%) and Trichuris trichuira 4 (1%) were detected. Age wise 5-8 years were more parasitized followed by 13-15 and 9-12 years of age (0.0296, P<0.05). Male children were highly (0.06700, P<0.05) infected than female. Children in Malakand district were found more infected followed by Dir Upper, similar infection rate was noted in children of districts Lower Dir and Swat (0.0192, P<0.05). Children in primary level were highly (0.0013, P<0.05) infected than those of middle and high levels. Enterobiosis is still the most common parasitic diseases in children. Studies on enterobiosis should be conducted time by time to recognize the hazardous of such parasitic infection in remote areas of the country.

As doenças causadas pela traça humana continuam sendo um problema de saúde pediátrica nos países em desenvolvimento, incluindo o Paquistão. Este estudo teve como objetivo investigar a prevalência de Enterobius vermicularis em escolares de quatro distritos na região de Malakand, Paquistão. Quatrocentos espécimes fecais foram selecionados de maio de 2014 a julho de 2017, usando solução salina normal e solução de lugol iodo. Vinte e três (5,75%) indivíduos foram encontrados infectados por E. vermicularis. Cinco crianças (1,25%) foram infectadas apenas com E. vermicularis e dezoito (4,5%) foram misturadas com outros helmintos. Foram detectados E. vermicularis 23 (5,75%), ancilóstomo 11 (2,75%), Ascaris lumbricoides 5 (1,25%), Taenia saginata 2 (0,5%) e Trichuris trichuira 4 (1%). Com relação à idade, 5-8 anos foram mais parasitados, seguidos por 13-15 e 9-12 anos de idade (0,0296, P <0,05). Crianças do sexo masculino foram altamente (0,06700, P <0,05) infectadas do que as do sexo feminino. As crianças no distrito de Malakand foram encontradas mais infectadas, seguidas por Dir Upper, taxa de infecção semelhante foi observada em crianças dos distritos Lower Dir e Swat (0,0192, P <0,05). As crianças do nível primário foram altamente (0,0013, P <0,05) infectadas do que as dos níveis médio e alto. A enterobiose ainda é a doença parasitária mais comum em crianças. Os estudos sobre enterobiose devem ser conduzidos periodicamente para reconhecer a periculosidade dessa infecção parasitária em áreas remotas do país.

Retrospective analysis and time series forecasting with automated machine learning of ascariasis, enterobiasis and cystic echinococcosis in Romania.

The epidemiology of neglected tropical diseases (NTD) is persistently underprioritized, despite NTD being widespread among the poorest populations and in the least developed countries on earth. This situation necessitates thorough and efficient public health intervention. Romania is at the brink of becoming a developed country. However, this South-Eastern European country appears to be a region that is susceptible to an underestimated burden of parasitic diseases despite recent public health reforms. Moreover, there is an evident lack of new epidemiologic data on NTD after Romania's accession to the European Union (EU) in 2007. Using the national ICD-10 dataset for hospitalized patients in Romania, we generated time series datasets for 2008-2018. The objective was to gain deep understanding of the epidemiological distribution of three selected and highly endemic parasitic diseases, namely, ascariasis, enterobiasis and cystic echinococcosis (CE), during this period and forecast their courses for the ensuing two years. Through descriptive and inferential analysis, we observed a decline in case numbers for all three NTD. Several distributional particularities at regional level emerged. Furthermore, we performed predictions using a novel automated time series (AutoTS) machine learning tool and could interestingly show a stable course for these parasitic NTD. Such predictions can help public health officials and medical organizations to implement targeted disease prevention and control. To our knowledge, this is the first study involving a retrospective analysis of ascariasis, enterobiasis and CE on a nationwide scale in Romania. It is also the first to use AutoTS technology for parasitic NTD.

Double parasite in appendicectomy specimen: Causal factor or incidental finding?

Appendicitis is the most common cause of acute abdomen leading to invasive surgery. While the mainstay treatment of appendicitis is appendicectomy, there are a few conditions where conservative medical treatment cures the patient. One such condition is intestinal parasitosis, where only pharmacotherapy causes remission. Although Enterobius vermicularis is the commonest parasite in this regard, others such as Schistosoma, Taenia, Ascaris and Trichuris can also be found. Coexistence of two parasites in appendicectomy specimen is distinctly rare. We present one such case here of double infestation with Enterobius and Trichuris in the appendix.

A Rare Cause of Acute Appendicitis: Enterobius vermicularis

Acute appendicitis is the most common intra-abdominal pathology that requires emergency surgery in general surgery clinics. The aetiology of acute appendicitis includes both infectious and non-infectious causes. Although parasitic diseases are rare in developed countries, they are more common in developing countries. The association between acute appendicitis and parasitic infections is unclear, and whether parasites are the cause of acute appendicitis is still under debate. In addition, many appendix parasites are encountered after appendectomy. In this study, we report a rare case of acute appendicitis caused by Enterobius vermicularis.

Factores asociados a enterobiosis en niños de dos comunidades nativas Ese'Eja del departamento Madre de Dios, Perú / Factors associated with enterobiosis in children of the Ese'Eja native communities in department of Madre de Dios, Peru

Introducción: La enterobiosis es una de las principales infecciones intestinales del mundo. Objetivo: Determinar los factores asociados a la infección por Enterobius vermicularis en niños de dos comunidades nativas Ese'Eja en Madre de Dios, Perú. Métodos: Estudio transversal analítico. Se trabajó con niños (77) de 1 a 11 años durante los meses de febrero a marzo de 2014. Para diagnosticar la enterobiosis se usó el test de Graham. Las manifestaciones clínicas fueron evaluadas por un médico y los factores asociados mediante una encuesta aplicada a los padres de los niños evaluados. Se usó estadística descriptiva y analítica, se utilizaron razones de prevalencia crudas y ajustadas con un IC 95 por ciento se consideró p< 0,05 como significativo. Resultados: La prevalencia de enterobiosis fue de 32,47 por ciento (25). Los factores asociados (RP e IC 95 por ciento) en el análisis bivariado fueron onicofagia 2,1 (1,1-3,9), chuparse los dedos 5,4 (2,1-2,7), uñas largas 7 (2,6-18,6), intercambio de ropa 2,3 (1,1-3,7), cambio de ropa interior 3,3 (1,8-5,9), uso de calzado 7 (2,6-18,4), juego con tierra 6,9 (1,7-27,3), juego con mascotas 6,4 (2,1-19,7), lavado de manos antes de comer 7,9 (3,6-17,1), lavado de manos después de comer 1,9 (1,7-3,66), 6 o más personas en la casa 3,9 (1,9-7,9), disposición de excretas a campo abierto 3,3 (1,7-6,2) y el menor nivel socioeconómico 2,6 (1,3-5,4). No hubo asociaciones en el análisis multivariado. Conclusiones: Existe una alta prevalencia de enterobiosis en la población estudiada y los factores de riesgo son similares a los antecedentes locales. Urge hacer programas de prevención y promoción de salud respecto al tema para reducir este problema(AU)

Introduction: Enterobiasis is one of the main intestinal infections worldwide. Objective: Determine the factors associated to Enterobius vermicularis infection in children from two native Ese'Eja communities in Madre de Dios, Peru. Methods: An analytical cross-sectional study was conducted in February-March 2014 of 77 children aged 1-11 years. Enterobiasis diagnosis was based on Graham's test. Clinical manifestations were evaluated by a physician, whereas associated factors were determined through a survey applied to the parents of the children studied. Use was made of descriptive and analytical statistical analysis, and crude and adjusted prevalence ratios with a CI of 95 percent. A p value of 0.05 was considered significant. Results: Enterobiasis prevalence was 32.47 percent (25). The associated factors (PR and CI 95 percent) in the bivariate analysis were onychophagia 2.1 (1.1-3.9), finger sucking 5.4 (2.1-2.7), long nails 7 (2.6-18.6), exchanging clothes 2.3 (1.1-3.7), changing underwear 3.3 (1.8-5.9), wearing shoes 7 (2.6-18.4), playing with earth 6.9 (1.7-27.3), playing with pets 6.4 (2.1-19.7), handwashing before eating 7.9 (3.6-17.1), handwashing after eating 1.9 (1.7-3.66), six or more people in the household 3.9 (1.9-7.9), feces disposal in open areas 3.3 (1.7-6.2) and a lower socioeconomic level 2.6 (1.3-5.4). Multivariate analysis did not find any association. Conclusions: Enterobiasis prevalence is high in the population studied, and the risk factors are similar to the local antecedents. It is urgent to develop health prevention and promotion programs about the topic to reduce this problem(AU)

Peritoneal lesions caused by Enterobius vermicularis suspected to be metastases of ovarian malignancy.

Enterobius vermicularis, also known as pinworm, is a helminth that commonly causes intestinal parasitic infestation. E. vermicularis can also cause extraintestinal infestations. We report a case of lower abdominal pain and intermittent vaginal bleeding in a 45-year-old woman who was referred to our gynaecology department. On investigation, a transvaginal ultrasound showed a multilocular cyst in the left ovary, along with elevated levels of cancer antigen 125. Consequently, a laparoscopic salpingo-oophorectomy was performed. A biopsy of atypical peritoneal lesions revealed remains of E. vermicularis Peritoneal lesions are a rare complication of enterobiasis, and the diagnosis of this complication is usually delayed by limitations in diagnostic options. Although extraintestinal enterobiasis does not require treatment because it is the last stage of the parasitic cycle, primary intestinal infestation requires treatment with mebendazole.

Small bowel intussusception and Enterobius vermicularis infestation in a 20-year-old woman.

A 20-year-old woman presented with abdominal pain and MRI findings of intussusception of the distal small bowel with no identifiable lead point and no visualisation of the appendix. A diagnostic laparoscopy succeeded in manually reducing the intussusception but was unable to find any candidate lead point. Intraoperatively, hyperperistalsis was observed throughout the small bowel which seemed prone to transient intussusception. Incidental appendectomy revealed an uninflamed appendix with Enterobius vermicularis (pinworm) infestation, the most common parasite present in appendectomy specimens worldwide. Although intussusception in young adults is an uncommon occurrence, the unique nature of this case is amplified by the concurrent finding of E. vermicularis infection of the appendix in an adolescent in western Canada, a phenomenon normally observed in paediatric populations with higher incidence in tropical areas. Although the mechanism of intussusception in this patient remains unclear, it is hypothesised that E. vermicularis colonisation acted as an irritant stimulating intestinal hypercontractility with resulting intussusception. Successful medical eradication of the pinworm in this individual may prevent future recurrence.