A rare cause of appendicitis in adults: Parasitic appendicitis

Acute appendicitis (AA) is the most common indication for emergency surgery in general surgery worldwide, with peak incidence occurring in the second and fifth decades of life. The main symptoms include nausea, vomiting, and pain that typically begins around the umbilicus and migrates to the lower right quadrant. While the most frequent cause is fekaloids, intestinal parasites, tumors, and fruit seeds may also rarely contribute to the etiology of appendicitis. The aim of this study was to determine the incidence of parasitic infections in the etiology of AA, along with associated demographic and histopathological findings in adult patients who underwent appendectomy.

The records of 10,658 patients over the age of 15 who underwent appendectomy between January 2011 and January 2023 were retrospectively reviewed. Based on histopathological findings, 114 patients who underwent appendectomy due to parasitic infestation were included in the study.

According to the pathology results, a total of 114 patients underwent appendectomy due to parasitic infestation. Of these, 53 (46.5%) were female and 61 (53.5%) were male. Histopathological examination revealed that 70 cases (61.4%) were diagnosed as acute appendicitis, 22 (19.3%) as suppurative, 15 (13.2%) as gangrenous, and seven (6.1%) as perforated appendicitis. In terms of etiology, Taenia saginata was identified in four patients (3.5%), Ascaris lumbricoides in two patients (1.8%), and Enterobius vermicularis (EV) eggs or parasites in 108 patients (94.7%).

Parasitic infections, particularly Enterobius vermicularis, may contribute to the development of acute appendicitis, although their exact role in the pathogenesis remains unclear. In our study, Enterobius vermicularis was the most common cause of parasite-related appendicitis.