# Enterobius vermicularis as an Intraoperative Surprise in a Child With Suspected Appendicitis and Normal Laboratory Findings

## TL;DR

A child with suspected appendicitis had a parasitic infection instead, showing normal lab results and highlighting the need to consider parasites in diagnosis.

## Contribution

This case report highlights the diagnostic challenge of Enterobius vermicularis mimicking appendicitis in children with normal inflammatory markers.

## Key findings

- A child with suspected appendicitis had Enterobius vermicularis worms found during surgery.
- Histopathology confirmed the presence of E. vermicularis without acute inflammation.
- The patient recovered after antihelminthic treatment with albendazole.

## Abstract

Acute appendicitis is a common surgical emergency in children, typically associated with elevated inflammatory markers and classical clinical presentation. However, parasitic infections such as Enterobius vermicularis can occasionally mimic appendicitis and represent a diagnostic challenge. Herein, we report a case of a nine-year-old female child who presented with right iliac fossa (RIP) abdominal pain and vomiting with normal white blood cell count and C-reactive protein (CRP) levels. Ultrasound imaging suggested early appendicitis, and therefore, a laparoscopic appendectomy was performed. Intraoperatively, multiple E. vermicularis worms were found within the appendiceal stump. Histopathological examination revealed no acute inflammation, but confirmed the presence of the E. vermicularis in the lumen. The patient recovered uneventfully and received antihelminthic therapy with albendazole. This case highlights the importance of considering parasitic infections in the differential diagnosis of appendicitis, particularly in pediatric patients with atypical presentations. It also emphasizes the diagnostic value of intraoperative findings and histopathology in guiding postoperative management.