Pinworms and Appendicitis: About 10 Cases with Review of Literature

Abstract

The pinworm is due to helminthes, Enterobius Vermicularis. It is a cosmopolitan digestive parasitosis and very frequent. It is a colic parasitosis because adult’s pinworms live in the cecum. Since the pinworm was found in the lumen of the appendix, its role in triggering inflammatory processes responsible for appendicitis was raised, with the persisting question: what is the role of pinworms in the appendicitis? In our retrospective study, we analyzed a series of 10 cases of appendicular pinworms (5 males/ 5 females, aged between 6 and 54 years) among 1224 appendectomies, collected over the period (February 2008-December 2015) at the 5th Military Hospital of Guelmim. We studied epidemiological, clinical, paraclinical, therapeutic and pathological aspects. A literature review has been given, in order to compare our data with those published from different hospitals around the world. An important part of the literature, concerning the appendicular pinworm, has raised the issue related to the high rates of negative appendectomies. Indeed, the presence of pinworms in the appendix can lead to appendicular syndrome independently of the presence of a histological inflammation. Moreover, the low incidence of pinworms in appendectomy specimens and the high rate of negative appendectomies with presence of Enterobius Vermicularis, support the hypothesis that pinworms do not cause appendicitis. As conclusion of this work, we emphasize the importance of thinking about the possibility of pinworms infection for patients with appendicitis syndrome. In the absence of surgical emergencies, a comprehensive examination with repeated parasitic scotch-test is recommended. The positivity of these tests would reduce the number of negative appendectomies. In this case, a simple antiparasitic treatment is sufficient.