Incidental appendectomy identifying appendiceal schistosomiasis during elective TAPP inguinal hernia repair: a case...

Schistosomiasis is a waterborne parasitic disease affecting over 250 million people worldwide, predominantly in Africa and Asia. Appendiceal involvement is rare, with reported prevalence rates of 1.3%-3.2%. Incidental appendectomy - removal of a macroscopically normal appendix during unrelated abdominal surgery - remains debated but may occasionally reveal unexpected pathology.

We describe a middle-aged male with long-standing right groin swelling, discomfort, and a remote history of hematuria who underwent elective laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Intraoperatively, multiple small white nodules were noted on a thickened appendix. An incidental appendectomy was performed, and histopathology demonstrated schistosomal appendicitis with granulomatous inflammation. The patient had no gastrointestinal symptoms prior to surgery. He recovered uneventfully and was subsequently treated with praziquantel.

Appendiceal schistosomiasis is an uncommon manifestation of schistosomiasis and is rarely diagnosed preoperatively. In this case, incidental appendectomy was essential in establishing the diagnosis. The TAPP approach provided a comprehensive view of the peritoneal cavity, allowing identification of unexpected pathology and highlighting its diagnostic advantage over alternative hernia repair techniques. Based on available literature, this appears to be the first incidental case identified during hernia repair in Somalia.

This case underscores the importance of considering parasitic infections when encountering unexpected intra-abdominal findings in endemic regions. It also demonstrates the diagnostic value of incidental appendectomy and the benefit of the TAPP approach in enabling early detection of silent pathology.