Rare Parasitic Causes of Acute Appendicitis: Enterobius Vermicularis in Focus

Background: Acute appendicitis is one of the most common causes of emergency surgery. Usually, it occurs due to luminal obstruction. However, enterobius vermicularis (EV) infections can also contribute to appendiceal pathology. EV may mimic symptoms of appendicitis, complicating diagnosis. Anthelmintic therapy emerges as a potential alternative to surgery in cases without inflammation. Materials and Methods: Appendectomy cases from May 2020 to April 2024 were retrospectively analyzed. EV-positive patients were compared with age- and gender-matched controls. Parameters such as white blood cell count (WBC), appendix diameter, and imaging findings were examined using blood tests and computed tomography (CT) imaging. Results: Among 2,599 cases, 13 were EV-positive (0.5%). WBC levels (10.6±1.8x103/mm3) and appendix diameter (10.1±1.0 mm) were significantly lower in the EV group compared to controls. No significant differences were observed in neutrophil count, C-reactive protein levels, or signs of inflammation. The appendix diameter on CT has shown high sensitivity in excluding EV cases, but its specificity is low. Conclusion: EV infestation often presents symptoms like appendicitis without causing histological inflammation, potentially leading to unnecessary surgeries. Anthelmintic therapy is a promising alternative. Retrospective analysis limits this study and underlines the need for prospective research, which should include symptoms like pruritus ani, to enhance diagnostic accuracy. Differentiating EV-related appendiceal symptoms from acute appendicitis is crucial to avoid unnecessary surgeries. Developing diagnostic tools and clinical algorithms could allow for non-operative management with targeted anthelmintic therapy, providing a promising alternative for EV-positive cases.