Asian Journal of Case Reports in Surgery

Enterobius vermicularis (pinworm) is a common intestinal helminth infection worldwide, particularly in developing regions. Although typically associated with mild gastrointestinal symptoms, its role in acute appendicitis remains controversial, with reports suggesting it may mimic or contribute to appendiceal inflammation.

We report the case of an 18-year-old female who presented with persistent lower abdominal pain, nausea, and anorexia. Clinical findings raised suspicion of acute appendicitis; however, ultrasonography was unremarkable and did not reveal definitive features of appendiceal inflammation. Despite negative imaging results, persistent symptoms necessitated surgical intervention.

Diagnostic laparoscopy and appendectomy were performed. Intraoperatively, the appendix was found to be inflamed and dilated, and a live E. vermicularis worm was observed emerging from the appendiceal lumen following transection, confirming appendiceal enterobiasis. Histopathology showed nonspecific chronic inflammatory changes. The patient received postoperative anti-helminthic therapy with albendazole and had an uneventful recovery with complete symptom resolution.

This case highlights the diagnostic challenge of parasitic appendiceal disease, particularly when routine laboratory and imaging findings are inconclusive. It underscores the importance of considering helminthic infection in patients with atypical presentations of suspected appendicitis, especially in endemic and resource-limited settings.