Isolated Appendiceal Pinworms on Colonoscopy

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A 10-year-old girl without significant medical history presented with 5 months of right lower quadrant abdominal pain. Previous workup was unremarkable, including complete blood cell count, blood and liver chemistries, C-reactive protein, celiac screen, stool ova and parasites, and fecal calprotectin. Normal imaging included abdominal ultrasounds and x-ray. She underwent an endoscopic evaluation, which was unremarkable except for numerous pinworms entering and exiting the appendiceal orifice. The patient and her home contacts were treated with albendazole. Her pain abruptly worsened 3 days later, and she had an open inversion appendectomy. Afterward, her symptoms resolved completely.
Stool examination for Enterobius vermicularis is a poor test and yields a positive diagnosis in only 5% to 15% of infected individuals (1). Serial cellophane tape testing, however, has a sensitivity of approximately 90% (2). E vermicularis has also been reported to mimic symptoms of acute appendicitis, although it causing appendicitis remains debated. Fleming et al (3) found 69% of appendix specimens containing E vermicularis did not have appendicitis. A case series by Ariyarathenam et al (4) showed 1 in 6 patients with E vermicularis had appendicitis. Discovering an infestation can be unexpected during appendectomy, and special techniques (eg, 3-endoloop technique, endostapling, port exteriorization) can prevent peritoneal contamination (see Supplemental Digital Content, Video,
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