"Diagnostic challenges, atypical presentations, and therapeutic implications in ectopic Enterobius vermicularis...

Enterobius vermicularis is recognized as the second most common human nematode, primarily inhabiting the gastrointestinal tract and mostly affecting children. However, ectopic infections (where the parasite migrates to the extra intestinal sites) although rare, have been increasingly reported and pose diagnostic challenges due to atypical clinical presentations.

A systematic review following PRISMA guideline was conducted by searching PubMed, Scopus, Web of Science, and Google Scholar for relevant articles published from 1972 to July 2025. Forty articles reporting 49 patients from 26 countries met the inclusion criteria. Data on demographics, sites involved, symptoms, diagnostic method, and treatment were extracted and analyzed descriptively.

The female reproductive system (uterus, fallopian tubes, ovaries) was the most frequently affected site (44.9 %), followed by abdominal and pelvic cavities. Abdominal pain was the most common symptom, accompanied by gastrointestinal complaints, vaginal bleeding, and urinary symptoms. Definitive diagnosis was mostly achieved via histopathological examination post-surgery, as non-invasive diagnostic tools demonstrated limited sensitivity. Treatment predominately involved anthelmintic medications such as mebendazole or albendazole; however, advanced cases often required surgical interventions, including hysterectomy, salpingectomy, oophorectomy, or appendectomy. Three fatalities were reported despite treatment.

Ectopic E. vermicularis infection can affect diverse organs and present with non-specific symptoms, frequently causing delays in diagnosis and unnecessary invasive procedures. Increased awareness among clinicians, alongside the use of adjunct non-invasive and molecular diagnostic methods, is crucial for early detection, complication prevention, and minimizing surgical interventions.