Enterobius vermicularis and its role in paediatric appendicitis: protection or predisposition?

Abstract

E . vermicularis was found to be more common in females and those of European descent. Seventy-seven percent of patients with E . vermicularis did not have concurrent acute inflammation of the appendix on histological examination. The question remains as to whether infestation is protective of inflammation or whether infestation causes appendiceal colic and subsequent appendicectomy of a non-inflamed appendix, thereby protective of the morbidity of acute appendicitis.

Needles in the haystack: Enterobius vermicularis in the appendix

“…Our case had no eosinophilia. It has also been observed that EV is more commonly found in appendices removed from females and children of European descent . These factors were present in our patient (Table ).…”

“…EV is commonly found on appendicectomy. In developed countries, EV has been confirmed histologically in 1.2–7.1% of appendicectomy specimens . For many years, it has been assumed that EV leads to appendicitis by blocking the lumen.…”

“…For many years, it has been assumed that EV leads to appendicitis by blocking the lumen. However, there are a wide range of findings on pathology, with between 23 and 71% of the specimens showing histological inflammation . A recent Australasian study showed that 77% of EV appendicectomy specimens were not inflamed .…”

“…However, there are a wide range of findings on pathology, with between 23 and 71% of the specimens showing histological inflammation . A recent Australasian study showed that 77% of EV appendicectomy specimens were not inflamed . This raised the possibility that, in these cases, EV infestation was incidental or even protective against appendicitis.…”

“…The authors postulated that adult EV worms block the appendiceal lumen, triggering colicky contractions. As the colic precedes the development of acute appendicitis, it may be considered protective against more significant morbidity …”