Enterobius vermicularis-associated appendicitis in adults: a 14-year single-center retrospective analysis of 8,139 appendectomy specimens

Enterobius vermicularis is the most prevalent intestinal helminth worldwide, yet its role in appendiceal pathology in adults remains debated. This retrospective cross-sectional study evaluated all 8,139 appendectomy specimens from patients aged ≥ 18 years at Denizli Servergazi State Hospital, a 304-bed secondary care community hospital in Denizli, Turkey (population ~ 1,061,000), between January 2009 and December 2024. E. vermicularis was identified in 48 specimens (0.58%). The female-to-male ratio was 1.4:1, and the mean age was 31.6 years. Leukocytosis was present in 56.2%, elevated CRP in 41.7%, and peripheral eosinophilia in 20.8%. All 48 cases exhibited histopathological evidence of acute appendiceal inflammation. Because only clinically indicated appendectomies were examined, this uniformity is expected by the study design and does not by itself distinguish a pathogenic from a bystander role. It nonetheless contrasts with pediatric series where up to 62.5% of parasitized appendices lack inflammation. Direct luminal obstruction by the parasite was documented in only 2 cases (4.2%), suggesting that mechanisms other than obstruction may mediate parasite-associated appendicitis. Routine histopathological examination of all resected appendices is essential for accurate diagnosis and appropriate anthelmintic management.