Parasitic Appendicitis: A Novel Laparoscopic Approach for the Prevention of Peritoneal Contamination

Abstract

Background/Aim Although rare, parasitic infection can cause acute appendicitis and result in contamination of the peritonea during appendectomy. The goal of this study was to summarize our experiences with parasitic appendicitis and describe a novel laparoscopic technique to prevent contamination. Method All patients diagnosed with acute appendicitis who underwent appendectomy between January 2016 and January 2017 were included in the study. All appendectomies were performed using the standard three-port laparoscopic method, and a video recording was made of each procedure. Following separation of the mesoappendix, a single endoloop was placed in the base of the appendix, and the appendix was then transected 3-4 mm above the clamp with the aid of a thermal cauterizing/sealing device. The appendix was extracted from the 10 mm trocar hole below the umbilicus and placed inside a bag prepared from a glove. After pathological confirmation of parasitic appendicitis, medical records were retrospectively analyzed in each case for whether peritoneal contamination had occurred or not. Results Out of 97 appendectomies, parasitic infection was observed in 4 cases, as confirmed by pathological examination. In two of these patients, E. vermicularis was detected, while the other two were infected with Balantidium coli. Intraoperative contamination did not occur in any of the cases, and retrospective review of the video recordings indicated no peritoneal contamination. Conclusion As a result of the coagulation and sealing effects of thermal devices, airtight seals were created on the residual appendiceal stumps, and consequently, no contamination was observed in any of the cases.

Balantidium coli apendicular como hallazgo incidental. Reporte de un caso

“…En un estudio desarrollado en Turquía por los departamentos de cirugía general de los hospitales de la universidad Yeni Yüzyil (Istanbul) y el Hospital de la universidad de Yuzucu (Van), el cual tenía como objetivo describir la técnica de apendicectomía laparoscópica para prevenir la contaminación peritoneal en los casos sospechosos de apendicitis aguda. Se reconoció la presencia de B.coli únicamente en 1 paciente de 97 estudiados 20 . En nuestro caso el paciente tampoco tenía cuadro clínico instaurado de apendicitis aguda puesto que fue extraída de manera preventiva durante un procedimiento de corrección de hernia ventral (incisional).…”

Diagnosis of parasitic infections in vermiform appendix in patients with appendicitis in Kirkuk city, Iraq

“…Some studies referred to the prevalence of E. vermicularis infection in children ages 5 to 14 years and the infection relatively uncommon in adults and infants under two years ages. Also, frequently infect females more than males [47,48].…”

The Vermiform Appendix and Its Pathologies

“…(tapeworm), Hymenolepis nana (dwarf tapeworm), Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), Schistosoma haematobium, Schistosoma mansoni, Giardia lamblia, and the protozoan Entamoeba histolytica [165,166]. Such parasite infections may further cause appendicular colic [167] or appendicitis [167][168][169].…”