Appendiceal taeniasis presenting like acute appendicitis

Acute eosinophilic appendicitis caused by Taenia saginata: A case report

Introduction

The role of parasites in the pathogenesis of appendicitis has been debated for a long time. To date, several gastrointestinal parasites have been reported as the causes of appendicitis in humans. Taenia infestation of the appendix is uncommon and few cases have been reported in the literature.

Presentation of case

We reported a case of acute eosinophilic appendicitis (AEA) in a 42-year-old woman caused by T. saginata in northern Iran. The patient was admitted to the emergency department with a 2-day history of acute abdominal pain in her lower right quadrant. Abdominal ultrasonography showed intra-abdominal bleeding and endometrium cysts. Routine hematological tests showed increases in white blood cell (WBC) count of 19.8 × 10³ per mcL with 3% eosinophilia. During abdominal laparotomy, peritoneal fluid was bulked with abdominal bleeding due to rupture of the uterine cyst. After investigation of inflammation in the appendix region, patient underwent appendectomy. Histopathological findings showed acute inflammation with eosinophils and a large number of round eggs with flattened segments of the genus Taenia. It is impossible to distinguish between T. saginata and T. solium based solely on egg morphology in the specimens. Therefore, based on history of the patient, which included no consumption of pork, the species was identified as T. saginata. At the three months follow-up, the patient was in good health.

Conclusion

In the current study, a case of AEA by T. saginata was reported. However, this was not the first case of acute appendicitis by T. saginata. Further studies are necessary to show roles of parasites in pathogenesis of AEA.

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T. saginata is distributed globally, and more frequent in developing countries.

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Taenia infestation of the appendix is uncommon and few cases have been reported in the literature.

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In the current study, a case of acute eosinophilic appendicitis caused by T. saginata was reported.

Epidemiology of Taenia saginata taeniosis/cysticercosis: a systematic review of the distribution in the Americas

BACKGROUND

The distribution of Taenia saginata in the Americas is unclear. Establishing the distribution, economic burden, and potentials for control of bovine cysticercosis is increasingly important due to the growing demand for beef. This paper aims to take the first step and reviews the recent distribution of T. saginata taeniosis and bovine cysticercosis on a national level within the Americas.

METHODS

We undertook a systematic review of published and grey literature for information on the occurrence, prevalence, and geographical distribution of bovine cysticercosis and human taeniosis in the 54 countries and territories of the Americas between January 1st, 1990 and December 31st, 2017. Data on bovine cysticercosis from OIE reports from 1994 to 2005 were also included.

RESULTS

We identified 66 papers from the Americas with data on the occurrence of taeniosis or bovine cysticercosis and an additional 19 OIE country reports on bovine cysticercosis. Taeniosis was reported from 13 countries, with nine of these countries reporting specifically T. saginata taeniosis, and four countries reporting non-species specific taeniosis. The reported prevalence of taeniosis ranged between 0.04-8.8%. Bovine cysticercosis was reported from 19 countries, nine identified through the literature search, and an additional 10 identified through the OIE country reports for notifiable diseases. The reported prevalence of bovine cysticercosis ranged between 0.1-19%. Disease occurrence was restricted to 21 countries within the Americas, the majority from the mainland, with the only island nations reporting either bovine cysticercosis or taeniosis being Cuba, Haiti, and the US Virgin Islands.

CONCLUSIONS

Taenia saginata is widely distributed across 21 of the 54 countries in the Americas, but insufficient epidemiological data are available to estimate the subnational spatial distribution, prevalence, incidence and intensity of infections. This needs to be addressed through active surveillance and disease detection programmes. Such programmes would improve the data quantity and quality, and may enable estimation of the economic burden due to bovine cysticercosis in the region in turn determining the requirement for and cost-effectiveness of control measures.

Unusual Histopathological Findings in Appendectomy Specimens: A Retrospective Analysis of 2047 Cases

Background. In this study, we retrospectively evaluated cases of patients who had undergone appendectomy in our hospital and aimed to present the efficiency of diagnostic tests and demographic data of cases. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis. In addition, the demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and reanalysis of archived resected appendix specimens was carried out. Methods. Files of 2047 patients (1329 males, 718 females, sex ratio: 1.85, age range: 1-87 years, mean age: 26, 50 years), who had been operated with a diagnosis of acute appendicitis in the emergency department of Bezmialem Vakıf University Medical Faculty from November 2011 to June 2014, were retrospectively evaluated. Results. Cases were separated into 2 groups. Cases with histopathologic examination reported as acute appendicitis constituted group 1 (n = 2013, 98.34%), and cases with pathologic findings other than acute appendicitis constituted group 2 (n = 34, 1.66%). The second group consisted of 8 low-grade mucinous neoplasms, 7 mucoceles, 6 carcinoid, 5 granulomatous inflammation, 4 intraluminal Enterobius vermicularis, 1 endometriosis externa, 1 adenocarcinoma infiltrated to serosa, 1 mesenteric cyst, and 1 low-grade adenocarcinoma formed in mucinous cystic neoplasm background. Conclusion. Acute appendicitis is the most common emergency surgical condition. Although most of the resected appendectomy specimens showed typical histopathologic findings, some (1.66%) showed unusual histopathologic findings. Even if the macroscopic appearance of the specimen is normal or acute appendicitis, we suggest routine histopathological examination.

Prevalence of Parasitic Infections in Surgically Removed Appendices: Parasitological and Histopathological Studies

Intestinal parasites may cause symptoms similar to acute appendicitis. Moreover, the diagnosis of parasitic infections is only done by post-operative histopathological examination of the appendices. Therefore, our aims are to assess the prevalence of intestinal parasitic infections among patients who were be appendectomized at Tanta Hospitals, Egypt and to investigate the possible association between these parasitic infections and appendicitis. To achieve these objectives, we performed a cross-sectional study including 65 patients chosen randomly who had undergone appendectomy over a period of one year from Oct 2015 to Oct 2016. Demographic data were retrieved. Complete blood picture was done. Moreover, appendiceal faecolith were examined macroscopically then by direct smear examination, formol-ether concentration technique, modified Ziehl-Nelseen stain and rapid immunochromatographic test. Histopathological examination of resected appendices was done. We found that parasitic infections were detected in 24.6 % of examined cases. Most of parasitic infections were prevalent in patients belonging to the school age group. Different parasitic infections were detected in the faecolith specimens. Moreover, Enterobious vermicularis adult female and Schistosoma mansoni granuloma were detected in histopathological sections. Also, a spectrum of pathological changes in the appendices was found ranging from lymphoid hyperplasia to acute inflammation with peritonitis. In conclusion, intestinal parasites may cause clinical picture similar to that of acute appendicitis. Therefore, careful attention to clinical history, stool examination and high eosinophilia may aid diagnosis and avoid unnecessary appendectomy. Moreover, the presence of different parasitic stages in the narrow lumen of the appendix may have a role in the development of appendicitis and this needs further studies.

Co-infection with Enterobius vermicularis and Taenia saginata mimicking acute appendicitis

In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged.

Unusual findings in appendectomy specimens of adults: retrospective analyses of 1466 patients and a review of literature

BACKGROUND

Diseases and tumors of the appendix vermiformis are very rare, except acute appendicitis.

OBJECTIVES

This retrospective study was conducted to document the unusual findings in appendectomy specimens.

PATIENTS AND METHODS

Data of 1466 adult patients were gathered retrospectively. Appendectomy was performed in 1169 and in 297 patients following a diagnosis of acute appendicitis and during other abdominal operations, respectively. The data of 57 (3.88 %) patients who were pathologically reported to have unusual appendix findings were retrospectively collected. The records were analyzed according to patients' age, gender, clinical presentations, operative reports, pathological reports and follow up.

RESULTS

Unusual pathologic examination findings were detected in the appendectomy specimens of 57 patients with a mean age of 48.34 ± 19. Twenty-nine patients (50.8 %) were male and 28 (49.2 %) were female. Normal appendix tissues were observed in specimens of 26 (45.6 %) patients and inflamed appendix in 31 (54.3 %). The most common unusual finding was parasitic diseases of the intestine. Pathological diagnosis of malignancy and benign features were reported in specimens of 14 and 43 patients, respectively. Macroscopic evaluation of appendectomy specimens during surgery might result in negligence of the presence of unusual pathology.

CONCLUSIONS

Even if the macroscopic appearance of the specimen is normal or acute appendicitis, we suggest routine histopathological examination.

Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients

The objective of this study was to analyze the clinical benefit of histopathologic analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. We retrospectively analyzed the demographic and histopathologic data of 1255 patients (712 males, 543 females; age range, 17-85 years) who underwent appendectomy to treat an initial diagnosis of acute appendicitis. Patients who underwent incidental appendectomy during other surgeries were excluded from the study. Histopathologic findings of the appendectomy specimens were used to confirm the initial diagnosis. Ninety-four percent of the appendectomy specimens were positive for appendicitis. Of those, 880 were phlegmonous appendicitis, 148 were gangrenous appendicitis with perforation, and the remaining 88 showed unusual histopathologic findings. In the 88 specimens with unusual pathology, fibrous obliteration was observed in 57 specimens, carcinoid tumor in 11, Encheliophis vermicularis parasite infection in 8, granulatomous inflammation in 6, appendiceal endometriosis in 2, and 1 specimen each showed mucocele, eosinophilic infiltration, Taenia saginata parasite infection, and appendicular diverticulitis. All carcinoid tumors were located in the distal appendix. Six of the 11 carcinoid tumors were defined by histopathology as involving tubular cells, and the other 5 as involving enterochromaffin cells. Six patients had muscularis propria invasion, 2 patients had submucosa invasion, 2 patients had mesoappendix invasion, and 1 patient had serosal invasion. All patients with tumors remained disease free during the follow-up (range, 1-27 months). We conclude that when the ratio of unusual pathologic findings for appendectomy specimens is considered, it is evident that all surgical specimens should be subjected to careful histologic examination.

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis.

METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out.

RESULTS: A total of 912 males and 709 females, from 16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy.

CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

Do intestinal parasitic infestations in patients with clinically acute appendicitis increase the rate of negative laparotomy? Analysis of 3863 cases from Turkey

INTRODUCTION

Acute appendicitis is the most frequently observed disease requiring emergency surgery. The role of parasites in its pathogenesis has long been discussed. The signs of the parasitic infestations can mimic the signs of acute appendicitis. Therefore, it can cause a negative laparotomy.

AIM

To evaluate the parasitic infestations of the appendix vermiformis whether increas the rate of negative laparotomy.

MATERIAL AND METHODS

The histopathology results of a total of 3863 patients who underwent appendectomy with clinically acute appendicitis were evaluated retrospectively. All appendectomy materials in which parasites were observed were evaluated with respect to the nature of the parasites and the findings of inflammation. Cases in which parasite tissue fragments and/or eggs as well as findings of inflammation were histopathologically observed in the appendix lumen were diagnosed with parasitic appendicitis.

RESULTS

Evidence of parasites was observed in 19 (0.49%) of the evaluated appendectomy materials. In 9 (47.3%) of these specimens that had evidence for parasites, findings for acute appendicitis and localized peritonitis were identified. Findings of acute appendicitis had not been identified in the other ten (52.7%) of the specimens. Enterobius vermicularis was the most frequently identified parasite.

CONCLUSIONS

In parasitic acute appendicitis, appendectomy in itself is not sufficient for treatment. Pharmacological treatment should also be administered after surgery. Patients should be evaluated prior to surgery for parasites, and diagnosis of acute appendicitis should be considered more cautiously in order to avoid negative laparotomies.

A rare case of gangrenous appendicitis by eggs of Taenia species

Cysticercosis and Taeniasis continue to be a major public health burden in the developing countries like India. Humans are the only definitive hosts infected by ingestion of eggs of Taenia species. Appendicular Taeniasis is rare with few isolated case reports during the past 30 years. Here, we report the case of a 38-year-old female patient from Nepal who presented with acute pain abdomen, was operated and diagnosed as suffering from gangrenous appendicitis caused by eggs of Taenia species.

Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

AIM: To document unusual findings in appendectomy specimens.

METHODS: The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens.

RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed.

CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

Appendicitis associated with Taenia species: cause or coincidental?

A 23-year-old woman from Ethiopia presented with acute abdominal pain. Exploratory laparotomy revealed appendicitis, pathology of which showed numerous eggs consistent with Taenia species. Although Taenia appendicitis is rare, it should be considered in the differential diagnosis of patients presenting with appendicitis from endemic parts of the world.

[Parasitic infection of the appendix and its possible relationship to acute appendicitis]

From 1,600 surgically removed appendices, 24 (1.5%) were found to have helminths. Enterobius vermicularis was observed in 23 of the 24 specimens (95.8%) and Taenia sp was detected in only 1 (4.2%) case. Sixteen patients (66.7%) were less than 10 year-old; 15 patients were male and 9 female. Pathologic analysis disclosed acute neutrophilic inflammation in 12 cases and lymphoid hyperplasia in 10 of the 24 appendices. Gangrenous appendicitis was diagnosed in 3 cases and peritonitis was found in 11 of the 24 infested appendices. Parasitic infection of the appendix is an uncommon cause of acute appendicitis in children and adolescents.

Parasitic infection of the appendix as a cause of acute appendicitis

The association between parasitic infection of the appendix and acute appendicitis has been widely investigated. The aim of this retrospective study was to evaluate the prevalence of parasitic infection of the appendix in a tropical area at southeast Brazil and to assess its possible relation to acute appendicitis in surgically removed appendices. Of the 1,600 appendectomies performed during a 10-year period, 24 (1.5%) were found to have helminths within the appendix. Enterobius vermicularis was observed in 23 of the 24 specimens (95.8%), and Taenia sp. was detected in only one case. Sixteen patients (66.7%) were less than 10 years old; 15 patients were male and nine female; 21 patients were white, and three were nonwhites. Pathologic analysis disclosed acute neutrophilic inflammation in the appendix wall in 12 of the 24 specimens and lymphoid hyperplasia in 10 of the 24 appendices. Gangrenous appendicitis was diagnosed in three cases, and peritonitis was found in 11 of the 24 infected appendices. The results of the present study indicate that E. vermicularis is the commonest worm found in the appendix and that its presence can cause pathologic changes ranging from lymphoid hyperplasia to acute phlegmonous inflammation with life-threatening complications like gangrene and peritonitis.

Incidental parasitic infestations in surgically removed appendices: a retrospective analysis

Background

Appendiceal parasites can cause symptoms of appendiceal pain, independent of microscopic evidence of acute inflammation. The diagnosis of a parasitic infestation is generally achieved only after the pathologic examination of the resected appendices.

Patients/Methods

Pathology department records were reviewed for all patients who required an operation for symptoms of acute appendicitis between 2000 and 2006. The specimens which were pathologically diagnosed to contain parasites were reevaluated for features of acute inflamation, and parasite type. The medical records were reviewed in detail to achieve a diagnostic score(Eskelinen). Radiologic imaging findings were correlated, if present.

Results

Of the 190 appendectomies performed, 6 specimens (3,15%) were found to contain parasites(4 Enterobius vermicularis, 2 Taenia subspecies). Appendectomies with Taenia showed acute inflamation, while acute inflamation was absent in the ones with Enterobius vermicularis. The Eskelinen score was higher than the treshold in two cases with an acute inflamation, and in two without. Ultrasound scans, and a computed tomography scan were performed in 5 patients. In 3 of 4 bland appendices, results favored acute appendicitis.

Conclusion

The diagnosis of gastrointestinal parasites is not only made by examining the stool but the diagnosis can be made by histology from surgical specimens. Timely diagnosis and appropriate therapy might prevent probable future complications that may necessitate surgical procedures, at least in some of the patients. The clinical management of these infections is different from that for classical appendicitis.