Mild acute pancreatitis with reactive appendicitis and ascariasis. A case report

Background: The coexistence of acute pancreatitis with reactive appendicitis and intestinal parasitosis is extremely rare and can complicate the differential diagnosis of acute abdomen. Case Report: A previously healthy 25-year-old female presented with generalized colicky abdominal pain, worsened by food intake, and accompanied by nausea, vomiting, and non-quantified fever. Physical examination revealed right iliac fossa tenderness without signs of peritoneal irritation. Subsequently, she vomited a parasite compatible with Ascaris lumbricoides. Laboratory tests showed leukocytosis (13,940/μL), amylase 2,735 U/L, and lipase 3,000 U/L. Abdominal ultrasound revealed findings consistent with appendicitis. A diagnosis of mild acute pancreatitis with reactive appendicitis and ascariasis was established. The patient was managed conservatively with intravenous fluids, ceftriaxone, and albendazole, with a favorable clinical outcome. Discussion: Reactive appendicitis can occur secondary to systemic inflammation or intra-abdominal infections, such as pancreatitis. Ascariasis, common in endemic regions, may exacerbate the inflammatory response or partially obstruct the appendiceal lumen. Medical management may be sufficient in selected cases. Conclusion: This case highlights the importance of considering secondary diagnoses and infectious or parasitic etiologies in patients presenting with abdominal pain, especially in endemic areas. Keywords: acute pancreatitis, Valentino’s syndrome, reactive appendicitis, ascariasis, Ascaris lumbricoides, acute abdominal pain