Appendiceal ascariasis in children

Abstract

Background: The propensity of Ascaris lumbricoides to wander leads to varied surgical complications in the abdomen. Wandering A lumbricoides may sometimes reach the vermiform appendix and its presence there may remain silent or incite pathology. Our aim was to study ascariadial appendicitis.

Methods: Over a period of 3 years, we identified children who were found to have appendiceal ascariasis during surgery for different intestinal complications due to ascariasis. We studied the relationship between ascariasis and its lodgement inside the vermiform appendix in these patients. No preoperative diagnosis was made in this series.

Results: We found 11 patients with appendiceal ascariasis. It was incidentally found that 8/11 (72.7%) patients had worms inside their vermiform appendix but not appendicitis, whereas the remaining three patients (27.2%) were found to have Ascaris-associated appendicitis. The characteristic finding in Ascaris-infested vermiform appendix was that the worm is positioned with its head at the base and its tail at the tip of the appendix.

Conclusion: Migration of A lumbrocoides inside the vermiform appendix is an incidental finding and tends to pursue a silent course in most patients. Only rarely does the presence of Ascaris inside the vermiform appendix cause appendicitis.

Figure 1

Long impacted worm bolus with transerosal visbility in a child who had incidental finding of worm inside appendix.

Figure 2

Enterotomy being done for impacted worm bolus in a child.

Figure 3

Ascaris lumbricoides being removed through tip of vermiform appendix in grossly normal appendix which has no evidence of any appendicitis at histopathology

Figure 4

Second worm being removed through above normal appendix.Worm lying with tail end at tip of appendix, held at tail end and being removed.

Figure 5

Ascaris lumbricoides with head end at base of appendix in a grossly inflammed appendix which had features of ascaridial appendicitis on histopathology.

Figure 6

Ascaris lumbrocoides which was lying with tail end lying at the tip and head end at base of grossly inflammed vermiform appendix.

Figure 7

Cross section of vermiform appendix having Ascaris lumbrocoides in lumen; no features of appendicitis can be seen.