Hidden schistosomiasis unveiled by appendicular peritonitis: A case report

Schistosomal appendicitis is a rare disease, with reported prevalence rates ranging from 1.31 to 3.2 %. The presented case underscores the critical significance of considering appendicular schistosomiasis as a potential etiology in cases of acute appendicitis, emphasizing the necessity of comprehensive histopathological examination for accurate diagnosis and appropriate postoperative management.

A 29-year-old man from Guinea, with no significant medical history, presented with vomiting, persistent abdominal pain, and fatigue over five days. Physical examination revealed signs of peritoneal irritation and imaging showed features indicative of acute appendicitis. An appendectomy was conducted laparoscopically. Histological examination confirmed gangrenous appendicitis with the presence of schistosome eggs, diagnosing acute gangrenous appendicitis with schistosomiasis. The patient recovered well postoperatively and was discharged after treatment with praziquantel.

The clinical presentation of schistosomal appendicitis resembles that of other acute appendicitis cases. When suspicion arises due to risk factors, confirming schistosomiasis may involve serology, polymerase chain reaction assays, and identifying eggs in urine or feces. Computed tomography findings cannot distinguish acute appendicitis caused by Schistosoma species from other causes.

Histopathological appendix analysis is crucial for detecting conditions like schistosomiasis, warranting postoperative care. Praziquantel therapy post-surgery is vital for eradicating the disease and preventing complications.