Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review.

INTRODUCTION: Enterobius vermicularis infestation of the vermiform appendix can mimic appendicitis. In these cases, laparoscopic appendicectomy runs a risk of contamination of the peritoneal cavity with worms. We reviewed our practice to suggest changes that will reduce the release of worms and propose methods to use in case contamination occurs.
METHODS: 498 patients underwent appendicectomy over a sixty-three month period. 13 (2.6%) patients had confirmed E. vermicularis on histology of whom 6 (46%) were performed laparoscopically. These patients' case notes were retrospectively reviewed.
RESULTS: The worms were noted intra-operatively during the laparoscopic appendectomies. In 2 cases, where peritoneal cavity contamination with worms occurred, they were dealt with careful diathermy or endoscopic suction. In the other cases, contamination was avoided by simple measures including division of the appendix in a staggered manner whilst maintaining traction, removal of worms using endoscopic suction or diathermy and quick transfer to a specimen bag.
CONCLUSION: We highlight that the symptoms of appendicitis can be due to Enterobius vermicularis infestation without any histological evidence of acute inflammation. Surgeons need to be aware of this possibility during laparoscopic appendicectomy and simple techniques can minimise the risk of contamination. It also enables early diagnosis and treatment without awaiting histological findings.