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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
0013-726X
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

10.1055/a-2387-3979
E-Videos-2024-05-5078-EV
E-Videos
Acute obstructive appendicitis in a child caused by pinworms treated with endoscopic direct appendicitis therapy
Cai Jun Dr.
Wang Yanli
Huang Silin MD
Liao Suhuan master's degree
Tan Yi Prof.
Cai Defeng Prof.
Huang Jin
1 Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
2 Department of Paediatrics, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
3 Department of Anesthesiology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
4 Department of Clinical Laboratory, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
5 Medical Department, Shenzhen Exit-Entry Frontier Inspection Station Hospital, Shenzhen, China
Correspondence Silin Huang, MD Department of Gastroenterology, South China Hospital, Medical School, Shenzhen UniversityNo. 1, Fuxin Road, Longgang DistrictShenzhenP.R. Chinasilinhuang@szu.edu.cn
04 9 2024
12 2024
1 9 2024
56 Suppl 1 E759E761
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Guangdong Province Clinical Teaching Base Teaching Reform Research Project2021JD086 National Natural Science Foundation of China82341019
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pmc A 10-year-old girl presented with a 1-day history of lower right abdominal pain, anorexia, nausea, and vomiting. Ultrasound revealed a tortuous appendix lumen with thick and rough walls ( Fig. 1 a ). Computed tomography (CT) scan showed an enlarged appendix with high-density fecaliths and enlarged lymph nodes ( Fig. 1 b ), leading to a diagnosis of acute obstructive appendicitis. After obtaining informed consent, we performed endoscopic direct appendicitis therapy (EDAT) using a 9-Fr cholangioscope (EyeMax; Micro-Tech, Nanjing, China) ( Video 1 ), which revealed numerous fecaliths caused by parasites in the appendiceal cavity ( Fig. 2 a ). These slightly white fecaliths, containing white-striped parasites, were extracted using a disposable basket ( Fig. 2 b ) and flushed with metronidazole and saline solution ( Fig. 2 c ). Numerous parasites were evacuated by negative pressure ( Fig. 2 d ), leaving the mucosa mildly congested ( Fig. 3 a ). The patient's abdominal discomfort rapidly improved. Follow-up CT showed the disappearance of the fecaliths and reduced inflammation ( Fig. 3 b ). Laboratory results confirmed the presence of Enterobius vermicularis, or pinworms ( Fig. 4 a–d ).

Fig. 1 a Ultrasound indicated abnormal curved tubular echo with thick and rough walls, suggesting acute appendicitis. b Computed tomography (CT) revealed enlarged appendix, fecal stones of high density, and enlarged surrounding lymph nodes.

Fig. 2 Endoscopic direct appendicitis therapy. a Fecaliths caused by parasites in the appendix cavity were slightly white through the cholangioscope. b Several fecaliths containing white striped parasites were meticulously extracted under the visual guidance of the cholangioscope. c Free live pinworms in the appendix cavity were flushed following repeated lavages with metronidazole and sodium chloride. d A large number of free parasites were flushed out into the intestinal cavity; they appear white and slender.

Fig. 3 a Through the cholangioscope, the appendiceal cavity was observed to be clear and the mucosa mildly congested. b Postoperative CT demonstrated disappearance of fecal stones compared to preoperative CT.

Fig. 4 The microscopic observation of E-vermicularis’ eggs in the liquid drawn out by negative pressure in the appendix cavity. a E-vermicularis eggs were colorless and transparent with a thick eggshell and no egg cover, resembling grains of rice. b The body of E-vermicularis: enlargement. c The head of E-vermicularis: the cuticle has horizontal stripes and expands to form the head wing. d The tail of E-vermicularis: straight and pointed.

Acute obstructive appendicitis in a child caused by pinworms treated with endoscopic direct appendicitis therapy.

Video 1

Enterobius vermicularis accounts for 7% of acute appendicitis cases and is associated with a higher rate of unnecessary appendectomies 1 . Traditionally, the diagnosis depended on surgical and pathological findings 2 3 . This case demonstrates the live morphology of pinworms in the appendix through a cholangioscope, illustrating how pinworms cause appendicitis by promoting the formation of fecaliths and subsequent obstruction. The patient was discharged on the first day after EDAT, highlighting its potential for minimally invasive treatment. This approach offers significant diagnostic advantages over other modalities and emphasizes the importance of technological integration in endoscopic practices.

Endoscopy_UCTN_Code_CCL_1AD_2AZ

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Conflict of Interest The authors declare that they have no conflict of interest.
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References

1 Fleming CA Kearney DE Moriarty P An evaluation of the relationship between Enterobius vermicularis infestation and acute appendicitis in a paediatric population – A retrospective cohort study Int J Surg 2015 18 154 158 25771103
2 Sousa J Hawkins R Shenoy A Enterobius vermicularis-associated appendicitis: A 22-year case series and comprehensive review of the literature J Pediatr Surg 2022 57 1494 1498 10.1016/j.jpedsurg.2021.09.038 34756582
3 Habashi R Lisi MP Acute appendicitis and Enterobius vermicularis infestation CMAJ 2019 191 E477 10.1503/cmaj.181194 31036611
