# A Case of Appendiceal Pinworms in an Adolescent Patient

## TL;DR

A 15-year-old girl with appendiceal pinworms presented with abdominal pain, but the diagnosis was only confirmed after surgery.

## Contribution

This case highlights the diagnostic challenge of appendiceal pinworms mimicking appendicitis without typical symptoms.

## Key findings

- Pinworms were found in the appendix despite normal CT and laparoscopic findings.
- Histological examination confirmed the presence of Enterobius vermicularis in the appendix.
- The case underscores the need for high clinical suspicion to avoid unnecessary surgery.

## Abstract

While pinworm infections are common among children and adolescents, pinworms mimicking appendicitis are relatively rare. Notably, such manifestations may present in the absence of typical signs and symptoms of appendicitis. The appendix may even appear normal on a computed tomography (CT) scan and upon laparoscopic examination. The current case report aims to expand the literature on appendiceal pinworms while also showcasing the diagnostic challenge that such cases may represent. A 15-year-old female presented to the emergency department with acute onset of right lower quadrant abdominal pain and vomiting. Initial imaging studies, including CT of the abdomen and pelvis, revealed a normal-appearing appendix and gallbladder. Initial laboratory examinations revealed anemia; leukocytosis was notably absent. Despite the unremarkable findings, the severity of her pain continued to increase, leading to the decision to perform a diagnostic laparoscopy with appendectomy. The procedure was uncomplicated, and the removed appendix appeared grossly normal. However, histological examination of the appendix revealed intraluminal Enterobius vermicularis without transmural inflammation. Medical management of pinworm infestations is relatively simple. However, appendiceal pinworm infestations may not be diagnosed until surgical intervention has been employed. Case reports such as these offer insight into the diagnostic challenge that may be posed by appendiceal pinworms, emphasizing that high clinical suspicion may be needed to avoid unnecessary surgery.