Intestinal helminths cause or mimic acute appendicitis?

Abstract Background: Helminthic infestation is considered to be a rare cause for acute appendicitis in both adults and children. Objectives: The main objective is to find out whether helminths play an active role in causing acute appendicitis or whether their infestation can mimic symptoms of appendicitis leading to a negative appendicectomy. Methods: This is a retrospective study done using the histology reports of patients who underwent appendicectomy after being diagnosed to have accute appndicitis at a surgical unit of the Teaching Hospital Karapitiya between January 2013 to July 2014. The 69 reports were reviewed for the presence of helminths and features of inflammation. Results: Out of the 67 five patients (7.24%) were positive for infestation with helminths in their histology. Nine appendices (13.04%) were not inflamed. However out of the 9 non-inflamed appendices, 3 (33.3%) were infested with helminths while of the total 58 inflamed appendices only 2 (3.33%) had helminths which is a statistically significant finding(P=0.0151). Conclusion: Helminthes can mimic acute appendicitis without causing inflammation. This leads to the misdiagnosis of Appendicitis. It is a well known fact that infestation and infection of the gastro intestinal tract leads to abdominal pain. When abdominal pain is confined to the right iliac fossa the misdiagnosis of appendicitis can be made as the symptoms are due to the mere presence of helminths and not due to them causing inflammation of the appendix. This leads to an otherwise unnecessary Surgery with the associated risks and costs related to Surgery, Anaesthesia and medication. Helminthic infestation can easily be eradicated with antihelminthic drugs which could prevent abdominal symptoms that led to an unneccesary / preventable appendicectomy.