Acute Appendicitis Complicated by Ascaris lumbricoides Infestation: A Case Report

Acute appendicitis is one of the most common causes of acute abdomen in surgery. That being said, helminthic infection, namely Ascaris lumbricoides, although not a very common cause of appendicitis, when occurring simultaneously, may mimic the same presentation as acute appendicitis, which may prove to be a challenging diagnostic hurdle that may affect the clinical course of patients and their management. We report the case of a 29-year-old female from the Philippines who presented with acute onset of right lower quadrant pain along with vomiting and localized tenderness on examination. Laboratory investigations showed marked leukocytosis. Computed tomography revealed an inflamed appendix along with multiple air-filled linear cavity changes and filling defects seen in the small and large bowel loops. These defects resemble a defect created by worm bodies outlined by intraluminal air and contrast. Laparoscopic appendectomy was uneventful. Postoperative recovery was marked by an episode of vomitus that contained living infestation of Ascaris, and the patient was treated with albendazole to eradicate remaining parasites. Histopathological results confirmed acute appendicitis. This case highlights the diagnostic challenge when parasitic infestation coexists with appendicitis, underscoring the importance of considering Ascaris in endemic regions.