The incidence reported of Enterobius Vermicularis infection leading to symptoms of acute appendicitis/appendicular pain in adults in Europe is around 2% but very few cases have been described in pregnancy. Infection is not always associated with eosinophilia and is most prevalent in children.
A 26 year old female presented with fevers, rigors and pyrexia of 39C to A&E. She had reduced appetite and gradually worsening right iliac fossa as well as right flank pain which was constant. There was no vomiting or urinary symptoms. On examination, she had mild tenderness in the right iliac fossa and right flank without signs of peritonism and no herniae. PR exam was normal and bimanual vaginal did not reveal adnexal tenderness, discharge or any masses or bleeding.
A formal Ultrasound scan reported: right kidney hypernephrotic, dilated renal pelvis and echogenic debris in renal pelvis. Appendix was not identified. Sludge was suggested in the right renal pelvis.CRP was raised but all other tests (including urine dipstick, WCC and eosinophils) were normal. Urine was send for MCS anyway.
The patient was taken to theatre for examination under anaesthesia, laparascopy and appendicectomy. The appendix was removed and sent for histology.
OUTCOME AND FOLLOW-UP
Post operatively, patients pain was relieved and she felt better. Urine MCS showed ova of enterobius vermicularis. Asshe was pregnant, all antihelminths were contraindicated and thus the patient was sent with information and advice to seek treatment from GP post delivery.