1 / 22

A”pin”dicitis : A Case of Adult Appendicitis in the Setting of Enterobius vermicularis .

A”pin”dicitis : A Case of Adult Appendicitis in the Setting of Enterobius vermicularis. LT Isaac Ilaoa DO (Associate) LCDR Catherine Berjohn MD, MPH (Associate) LCDR Nehkonti Adams MD (Associate) CAPT Mary Bavaro MD (Fellow) Department of Internal Medicine and Infectious Diseases

uma-garza
Download Presentation

A”pin”dicitis : A Case of Adult Appendicitis in the Setting of Enterobius vermicularis .

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A”pin”dicitis: A Case of Adult Appendicitis in the Setting of Enterobiusvermicularis. LT Isaac Ilaoa DO (Associate) LCDR Catherine Berjohn MD, MPH (Associate) LCDR Nehkonti Adams MD (Associate) CAPT Mary Bavaro MD (Fellow) Department of Internal Medicine and Infectious Diseases Naval Medical Center, San Diego, CA

  2. Case • 24 year old female presented with 36 hours of abdominal pain. • Described pain as: • Sharp/stabbing • Initially mid abdomen, but migrated to right lower quadrant • Unrelieved by Ibuprofen • Exacerbated by movement • Associated symptoms: • Nausea, with non-bloody emesis • Non-bloody diarrhea • Fever to 100.9 F • Review of systems: otherwise negative

  3. PMH • Past medical history surgical history • Depression • Generalized Anxiety • Past surgical history • Dilation and Curettage • Laparoscopy for left ovarian cyst (age 13) • Social history • Married, with 3 children • Denied Tobacco, Alcohol, or Illicit drug use

  4. Physical Exam • Vital signs: • Temperature: 97.5 degrees Fahrenheit • Blood pressure: 99/52 mmHg (consistent with baseline) • Heart Rate: 89 beats per minute • Respiratory rate: 18 respirations per minute • Oxygen saturation: 98% on room air • Physical: • Abdomen: • Soft, with bowel sounds present • Localized tenderness to right lower quadrant • Positive rebound tenderness • Positive guarding

  5. Labs/Rads • Complete blood cell count • Absolute Eosinophil count of 770 per microliter • (normal less than 500) • White blood cells: 9,400 per microliter • Normal metabolic panel • Urinalysis: within normal limits • Computerized Tomography of the abdomen and pelvis: • “borderline dilated appendix with surrounding inflammatory changes. An acute appendix is not excluded”.

  6. Enterobiusvermicularis:“The Pinworm” • Epidemiology: • Humans only known host • Predominance in… • Children (ages 5-9 years) • Closed-crowded living spaces • One of the most common human parasites • Prevalence estimated to be approximately 40 million in the United States

  7. Enterobiusvermicularis

  8. Clinical Manifestations • Most common symptom is perianal itching • Aka pruritus ani • Up to 1/3 can be asymptomatic • Other reported associations • Appendicitis • Mesenteric Abscess • Enterocolitis • Vulvovaginitis • Salpingitis, oophoritis

  9. Diagnosis

  10. Discussion • The role of E. vermicularisin appendicitis? • E. vermicularisdetected in 0.6 – 13 % of resected appendices. - Appendicitis versus “Appendiceal Colic”

  11. Adapted from: Table 1. Histological features of appendices

  12. Adapted from: Table 2. Pathology distribution of E. vermicularis

  13. Conclusion • Despite the high prevalence of E. vermicularis this case highlights an interesting and uncommon presentation of this infection. • Although there is a known relationship between pinworm infections and appendicitis, appendiceal colic was the most likely etiology in this case.

  14. References • Akbulut S, et al; Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review. World J Gastroenterol 2011 Apr21;17(15):1961-70. • Arca MJ, et al; Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature. PediatrSurgInt 2004 May; 20(5):372-5 • Centers for Disease Control and Prevention. Enterobiasis (Enteroblusvermicularis) www.dpd.cdc.gov/DPDx/HTML/Enterobiasis.htm (Accessed on Sep 25, 2014). no abstract available • DahlstromJ.E., et al; Enterobiusvermicularis: A possible cause of symptoms resembling appendicitis. Aust. N.Z. J. Surg. (1994) 64, 692-694, 1994 May 24 • Invisible Tape. Officeworks. 2008-2014. [http://officeworks.com.au/shop/officeworks/office-supplies/tape-and-dispensers/invisible-tape]

  15. Isik B, et al; AppendicealEnterobiusvermicularisinfestation in adults. IntSurg 2007 Jul-Aug; 92(4):221-5 • Lamps LW. Infectious causes of Appendicitis. Infect Dis Clin N Am 24 (2010) 995-1018. doi:10.1016/j.idc.2010.07.012 • Life cycle of Enterobiusvermicularis. Centers for Disease Control and Prevention. 2013 Jan 10. [http://www.dpd.cdc.gov/dpdx] • Ramezan M, et al; Relationship between Enterobiusvermicularis and the incidence of acute appendicitis. Dept of Community and Preventive Medicine, ISMSU Isfahan, Iran. Vol 38 No.1 January 2007

  16. Thank You • Any Questions?

More Related