Enterobius vermicularis (pinworm) infestation in a child presenting with symptoms of acute appendicitis: a wriggly tale!

Acute appendicitis is the most common surgical emergency worldwide. However, it can still present a challenging diagnosis especially in the young, elderly and those individuals of reproductive age, thus encompassing a wide spectrum of varied clinical presentations. Parasitic infections of the appendix are a rare cause of acute appendicitis. However, they must be considered in children presenting with abdominal pain. We report a case of Enterobius vermicularis infestation mimicking the features of acute appendicitis in a 10-year-old girl. This case is a cautionary reminder of the importance of considering E. vermicularis infestation in children presenting with abdominal pain, but who do not have a significantly raised white cell count or high Alvarado scores. A history of anal pruritus is the most characteristic symptom, but the parasites can cause severe abdominal pain mimicking appendicitis. Prompt recognition and a high clinical index of suspicion are required to prevent an unnecessary appendicectomy. Caution is advised when performing a laparoscopic appendectomy, as in our case, to prevent contamination of the peritoneum. This infestation is easily treatable with mebendazole.

Appendiceal pseudomyxoma peritonei in a pregnant woman.

One in 1000 cancers occur during pregnancy. Epithelial tumors of the appendix occur in approximately 1% of all colorectal tumors, and the occurrence of this neoplasm during pregnancy is extremely rare. We report an unusual case of pseudomyxoma peritonei (PMP) in a 41-year-old full-term pregnant woman. Cesarean section was carried out, and the abdomen was found to contain an appendiceal mucinous tumor with large volume PMP. This case illustrates the incidental nature of the disease and its occurrence in a pregnant woman with no clinical features during the antenatal period. A review of recent literature is also documented. Pseudomyxoma peritonei is commonly discovered during surgery for other conditions, and a high index of suspicion is required to make a diagnosis. Diagnostic modalities such as ultrasound, CT, and MRI can provide some evidence for PMP, but the definitive diagnosis is only made laparoscopically or by exploratory laparotomy.