Seeds or Parasites? Clinical and Histopathological Features of Seeds and Parasites in the Appendix

OBJECTIVE

Parasites and plant seeds may both be found in appendectomy specimens. Each plant seed has a different appearance and can thus exhibit wide variations under the microscope. Fragmented seeds may histologically mimic parasites. The differential diagnosis between seeds and parasites can be challenging in such cases. This study aimed to determine the incidence of parasites, seeds, and foreign bodies in appendectomy materials and highlight the most characteristic histopathological features associated with these structures.

MATERIAL AND METHOD

In this study, pathology slides of 9,480 patients, who underwent appendectomy between 2010 and 2021, were reviewed, and cases that contained parasites, seeds, or foreign bodies were identified. We reviewed the literature on seeds and parasites in appendectomy specimens.

RESULTS

Parasites were observed in 56 (0.6%) cases. Of these cases, 45 had Enterobius vermicularis (80%), and 11 had Taenia subspecies (20%). Plant seeds were observed in 47 cases (0.5%), and were macroscopically recognizable in 5 of them as olive, lemon, and cherry seeds. Parasites and seeds were usually observed in the lumen of appendix vermiformis, filled with abundant fecal materials.

CONCLUSION

Seeds are seen in approximately 0.5% of the appendectomy specimens. Though rarely seen, the fragmented seed appearance may cause diagnostic difficulties. In this context, the key morphological features of parasites and plant seeds outlined in this study may be helpful in their differential diagnosis.

Enterobius vermicularis: A Cause of Abdominal Pain Mimicking Acute Appendicitis in Children. A Retrospective Cohort Study

BACKGROUND

Enterobius vermicularis (EV) is the most common helminthic infection in the world. This small parasite is predominant in the pediatric population. The presence of EV in the appendix can cause or mimick appendicitis. The aim of our study was to compare patients with EV infection and those without EV infection, and to identify predictive factors that may help the diagnosis of EV infection in patients presenting with right iliac fossa pain and avoid negative appendectomy.

METHODS

A retrospective analysis of all the appendices removed between January 2012 and December 2016 was conducted at the department of pediatric surgery, Hedi Chaker Hospital, Sfax, Tunisia. According to the final histopathological diagnosis, patients with EV infection were compared to those without EV infection. Data including age, sex, white blood cell (WBC) count, neutrophil count, eosinophil count, C-reactive protein, and ultrasound results for both groups were analyzed and compared. The study protocol was approved by the local hospital ethics committee. Statistical analysis was performed using IBM SPSS, version 20. Descriptive analysis in the form of mean and standard deviation was performed on demographic information. Differences between groups were assessed using the student t-test for continuous variables and the χ2 test and Fisher exact test where appropriate for categorical variables.

RESULTS

In total, 540 pediatric appendectomies were performed. Overall, 63.5% of patients were male and 36.5% were female. Mean age was 9.28 ± 2.77 years. 22.2% of procedures were completed laparoscopically, 76.5% were open and 1.3% were converted. The negative appendectomy rate was 11.1%. EV was present in 9.8% of cases. Comparison of clinical, biological, and ultrasound findings between two groups of patients with EV (EV+) and those without EV (EV-) shows a statistical significance for pruritus ani (P < 0.001), WBC count (P < 0.001), neutrophil count (P < 0.001), C-reactive protein (CRP) (P = 0.001), positive ultrasound (P < 0.001), perforation rate (P = 0.009), and negative appendectomy rate (P < 0.001). No significant difference between the two groups was seen when comparing gender (P = 0.271), vomiting (P = 0.130), eosinophil count (P = 0.915), and procedure (P = 0.536).

CONCLUSION

EV was seen in 9.8% of pediatric appendectomies in our study. Pruritus ani, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain.

HISTOPATHOLOGICAL ANALYSIS OF SCHISTOSOMIASIS IN THE GASTROINTESTINAL TRACT WITH FIRST RECORD OF SCHISTOSOMAL APPENDICITIS FROM SOHAG, UPPER EGYPT

Schistosomiasis is a chronic granulomatous inflammation that affects many systems in the body including the gastrointestinal tract. Appendiceal schistosomiasis is also described and can be a precursor lesion of schistosomal appendicitis. The present study was done to make a retrospective analysis of histopathological changes in the gastrointestinal tract affected by Sckistosoma mansoni among patients attending Sohag University Hospital, Sohag Governorate between June 2013 and June 2016. A total of 150 colon and 30 appendix specimens were collected through out the period from male infected pa- tients aged between 35-50 years and suffering from abdominal pain and dysentery. Histopathological examination of the tissue biopsies was performed. 5p tissue sections were prepared and examined microscopically. Ten specimens were documented to have intestinal schistosomiasis, nine of the colon 9/150 (6%) were diagnosed as chronic schistosomal colitis and one of the appendix 1/30 (3.3%) as chronic schistosomal appendicitis. Microphotographs of the tissue sections were prepared for histopathological observations. Histopathological examination of all specimens revealed degenerated pinkish and calcified bluish bilharzial eggs in the submucosa and even musculosa with surrounding granulomatous reaction. Bilharzial polyps of the colon were detected in two specimens (20%) and bilharzial worms within venules of the muscle layer in two specimens (20%). During the present study, S. mansoni was documented as a not uncommon cause of chronic colitis and for the first time from Sohag as a cause of chronic appendicitis. All specimens did not show any malignant or premalignant cells.

[Discussion on ultrasonographic characteristics of schistosomal appendicitis lesions]

OBJECTIVE

To discuss the ultrasonographic characteristics of schistosomal appendicitis lesions.

METHODS

Among the patients with schistosomal hepatopathy who were discovered by Color Doppler ultrasound in Huzhou Central Hospital from January 2012 to December 2015, 50 cases with clear history of schistosomiasis and treatment were chosen as a schistosomal hepatopathy group, meanwhile, 50 normal people, who came from non-endemic areas, without schistosomal hepatopathy and schistosomiasis history were chosen as a control group. The two groups were examined by ultrasound scan of the appendix, and the data of the largest diameter of the appendix and the thickness of the appendix wall were collected, and the sonographic characteristics of their appendixes, such as whether the echo of the appendix wall was even or not, were observed.

RESULTS

The minimum internal diameter of the appendix cavity and the thickness of the appendix wall of the schistosomal hepatopathy group were (2.090 ± 0.790) mm and (1.332 ± 0.313) mm, respectively, the former was significantly narrower than that of the control group, while the latter was significantly thicker than that of the control group (t = 2.647, - 4.526, respectively, both P＜0.05). The proportions of those with inhomogeneous echo, indistinctness structure, uneven thickening of the appendix wall, as well as having intestinal contents in the appendix cavity in the schistosomal hepatopathy group were higher than those in the control group (χ² = 12.000, 18.537, 24.008, 4.244, respectively, all P＜0.05).

CONCLUSIONS

Schistosomal appendicitis lesions have obvious ultrasonographic characteristics under ultrasound. Ultrasound can play an important role in judging whether the appendix of schistosomiasis patients is involved and discovering the lesion of appendix early.

Acute blastocystis-associated appendicular peritonitis in a child, Casablanca, Morocco

Despite increasing reports that Blastocystis infection is associated with digestive symptoms, its pathogenicity remains controversial. We report appendicular peritonitis in a 9-year-old girl returning to France from Morocco. Only Blastocystis parasites were detected in stools, appendix, peritoneal liquid, and recto-uterine pouch. Simultaneous gastroenteritis in 26 members of the child's family suggested an outbreak.

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.

Manifestations of pediatric appendicopathia oxyurica

Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.

Significance of intraepithelial lymphocytes in appendix

The aim of this study was to investigate the importance of the increase in intraepithelial lymphocytes (IELs) in the mucosa of the appendix. One hundred and four retrospective appendectomy specimens were examined to evaluate the IELs. Intraepithelial lymphocytosis was identified in 11.5% (12 cases) of the specimens. Of these 12 cases, 6 cases with intraepithelial lymphocytosis were associated with parasitic infection. No increase in IELs was found in the 36 appendices that were removed in other primary operations. A wide range of immunologic stimuli can raise IELs in the gastrointestinal system. However, in appendectomies with clinical signs of acute appendicitis, an increase in IELs is more likely to be related to parasitic infection. This increase should be considered for the diagnosis of parasitic infections.

Appendiceal Enterobius vermicularis infestation in adults

The objective of this study is to evaluate the incidence of Enterobius vermicularis in the appendices of the adult population and a possible relationship between E. vermicularis and acute appendicitis. E. vermicularis was identified in 18 (2%) of 890 patients. Six hundred sixty-five operations were performed for presumptive diagnosis of acute appendicitis, and E. vermicularis was found in 12 (2%) patients. The histopathological examination revealed acute inflammatory cells in four cases (33%). Three of these four specimens included luminal ova and one E. vermicularis. Histopathological examination of six cases revealed E. vermicularis in 225 incidental appendectomies with no evidence of either acute or chronic inflammatory cells. This study suggests a relationship between the presence of E. vermicularis ova and acute inflammation, but the presence of the pinworm in the lumen of the appendix is coincidental. On the other hand E. vermicularis in the appendix lumen can cause symptoms of acute appendicitis.

Schistosomiasis of the appendix in Maiduguri

We retrospectively studied 27 histologically diagnosed cases of schistosomiasis of the appendix at the University of Maiduguri Teaching Hospital between January 1994 and December 2003. Of 1183 cases of appendices histologically examined, schistosomiasis was seen in 27 (2.3%).

Enterobius vermicularis causing symptoms of appendicitis in Nepal

This study set out to determine the prevalence of Enterobius vermicularis in surgically removed appendices and to assess the possible relation of the parasite to acute appendicitis. All 624 surgically removed appendices received in the Department of Pathology, BPKIHS, Dharan, Nepal during 2(1/2) years (August 1999-January 2002) were examined. E. vermicularis was identified in nine (1.62%) appendices from the patients with a clinical diagnosis of appendicitis. The parasite was most frequently seen in histologically normal appendices (6/71) and was rarely associated with histological change of acute appendicitis (3/539). No cases of E. vermicularis infestation occurred in appendices showing chronic inflammation or removed during the course of other surgical procedures. E. vermicularis was found more frequently in uninflamed and histologically normal appendices (8.45%) than those which were inflamed with histopathologic changes of acute appendicitis (0.56%). It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.

A rare cause of acute appendicitis: parasitic infection

The role of parasitic infection in the aetiology of acute appendicitis has been discussed for more than 100 years. The aim of this retrospective study was to determine the prevalence of parasitic infection in surgically removed appendices, and to identify whether this type of infection is associated with appendicitis. 104 appendices were removed from patients clinically diagnosed with acute appendicitis, and 30 were removed in the course of other surgical procedures. All the operations were performed at Baskent University Adana Hospital between January 1999 and December 2004. Enterobius vermicularis was identified in 4 (3.8%) appendices from patients with clinical appendicitis, and Entamoeba histolytica was detected in 1 (1.0%) appendix from this group. No parasites were found in the 30 appendices that were removed during other surgical procedures. Specimens from 3 of the 4 appendices with E. vermicularis showed no histological evidence of acute inflammation. It is concluded that parasites in the appendix may produce symptoms which resemble acute appendicitis, but parasitic infection rarely causes acute appendicitis.

Appendiceal taeniasis presenting like acute appendicitis

A case of parasitic appendicitis caused by Taenia sp. in a 28-year-old woman from Brazil is reported. Histopathological data and a description of the helminthe found in the appendix lumen are presented.

Schistosomal appendicitis in pregnancy

Acute appendicitis is the most common acute surgical infection during pregnancy. Although usually pyogenic in origin, parasitic infections account for a small percentage of cases. Despite the relatively high prevalence of acute appendicitis in our environment, it is not commonly associated with schistosomiasis. We report here the association of pregnancy and appendicitis caused by Schistosoma haematobium. Schistosomiasis is very common complication of pregnancy in hyperendemic areas. Schistosome egg masses can lodge throughout the body and cause acute inflammation of the appendix, liver and spleen. Congestion of pelvic vessels during pregnancy facilitates passage of eggs into the villi and intervillous spaces, causing an inflammatory reaction. Tourism and immigration make this disease a potential challenge for practitioners everywhere.

[The role of helminthiasis in the etiology of acute appendicitis]

279 vermiform processes removed for different form of appendicitis were studied hystologically with obligatory analysis of appendix content. High rate of helminth intestation (27.2%) in vermiform processes removed in acute appendicitis surgery confirms an important role of small helminths (Enterobius, Trichocephalis and their larvae) in acute appendicitis development. The incidence of acute appendicitis and helminths interstation in children is higher than in adults. All the patients with acute appendicitis need helminthological examination and etiotropic treatment because appendectomy eliminates the complication but not the cause of intestinal disease.

[Morphological diagnosis of various helminthiases during analysis of surgical specimens of appendices]

Appendices with intact content after appendectomy were studied histologically. On the appendixes content sections fragments of helminths parasitizing in the colon as well as their ova were often found. Determination of helminth invasion nature raises the efficiency of the pathologist's examination.

Malakoplakia of the appendix. An unusual association with eggs of Taenia species

Malakoplakia of the appendix is an unusual condition that has been reported to occur in association with tumors, infections, and immunocompromised states. We describe a case of appendicular malakoplakia associated with eggs of Taenia species. The diagnosis was made on histopathologic examination of surgically resected tissue from an appendicular mass. To the best of our knowledge, this is the first time that helminths have been documented to be associated with malakoplakia. We also discuss the implications of helminthic infestation in the pathogenesis of the lesion.

Spectrum of complicated intestinal amebiasis through resected specimens: incidence and outcome

BACKGROUND/PURPOSE

Entamoeba hystolytica (EH) is an enteric protozoan that may cause serious complications that require operative management in children. A retrospective clinical trial was performed to find out the incidence and outcome of complicated intestinal amebiasis (IA) by means of surgically resected specimens in children.

METHODS

The histopathologic evaluation of 554 intestinal specimens (including appendix and polyp) of 482 patients between 1980 and 1997, inclusive, were reviewed. Intestinal biopsy specimens taken from successfully medically treated patients with uncomplicated IA were excluded.

RESULTS

Complicated IA was noted in 18 children (3.7%) consisting of 7 girls and 11 boys with a mean age of 9.2+/-2.3 years. EH was present in the (1) appendices of 4 patients with perforated appendicitis and 3 patients with normal appendix who underwent negative exploration; (2) juvenile polyps of 4 patients presenting with hematochesia; (3) colonic wall of 1 patient presenting with intussusception and treated by resection and anastomosis; (4) cecum of 1 patient presenting with right lower quadrant mass and underwent exploration with the presumptive diagnosis of lymphoma; (5) colonic wall of 5 patients who underwent ileostomy followed by subtotal colectomy and endorectal pull-through with the presumptive diagnosis of chronic inflammatory bowel disease (n = 3), toxic megacolon + peritonitis (n = 1), and total colonic polyposis (n = 1). All above-mentioned patients are alive and free of symptoms.

CONCLUSIONS

The diagnosis of IA should be considered in a very wide spectrum of clinical appearances. IA may be associated with colonic polyps and perforated appendicitis, may act as a leading point for intussusception, and may mimic the clinical picture of appendicitis and lymphoma resulting in negative explorations. The diagnosis and treatment of complicated IA in patients who received a misdiagnosis of inflammatory bowel disease is a great challenge and requires major and emergency surgery.

Schistosomiasis: an unusual cause of right lower quadrant abdominal pain

Schistosomiasis, although unusual in North America, is a common disease worldwide. Symptoms vary depending on the species involved. Immigrants from endemic regions are the commonly affected patients found in North America. In most cases, schistosomiasis does not present with right lower quadrant pain. Even in endemic regions, this form of presentation is uncommon. In the United States, most cases of right lower quadrant pain often will be treated as appendicitis. Questions remain unanswered as to whether the schistosomes cause appendicitis or are found incidentally in these cases. Stool and urine specimens may be helpful in making a diagnosis. Most cases require operative intervention to rule out appendicitis and to obtain tissue for histopathologic diagnosis. Praziquantel is effective in eradicating infestations.

Comparative study of two methods for the diagnosis of Enterobius vermicularis in the appendix

A total of 1590 human appendices were collected and examined histologically for evidence of pinworm infection. The incidence of infection in appendices was 2.39%. In examining 100 appendices by both the histological and the parasitological methods, 3 and 7 samples respectively were seen to be infected by pinworm.

Migration of sporozoites and merogony of Eimeria coecicola in gut-associated lymphoid tissue

The invasive phase of Eimeria coecicola was studied during the first 80 h postinoculation (p.i.). Using a method that synchronized the life cycle, sporozoites were observed in the duodenum and the jejunum until 32 h p.i. They were seen first in the villous epithelial cells or in host cells resembling intraepithelial lymphocytes (IEL). Later they were observed in IEL in the lamina propria. After 48 h p.i., no coccidian stage was identifiable in the mucosa of the small intestine but sporozoites appeared in the lymphoid cells of lymphatic follicles of the gut-associated lymphoid tissue (vermiform appendix, sacculus rotundus, and Peyer's patches). The first merogony was observed 64 h p.i. in these lymphoid cells and in membranous epithelial cells (M-cells) but was never seen in the epithelium itself. Morphologically there were two types of meronts, depending on the host cell type, but in both cases the merozoites contained a refractile body and resembled sporozoites. The first meronts of the second generation were observed 80 h p.i. in the villous epithelial cells of the domes of the follicles of the gut-associated lymphoid tissue, where the further development of this Eimeria takes place. This pattern of invasion strongly suggests that sporozoites take an exclusively extraintestinal route to reach the target cells. Moreover, to our knowledge this is the first description of an eimerian merogony that does not take place in epithelial cells.

[Appendicitis and its atypical causes]

The authors analysed 2849 patients who were admitted to the Department of General Surgery, Regional Hospital in Pisz in the years 1980-1989 with symptoms suggestive of appendicitis. In 983 cases surgical intervention was abandoned, because the symptoms regressed spontaneously or were caused by diseases of other organs. The pathological conditions associated with appendicitis are analysed in 1866 surgically treated patients. Cases of appendicitis caused by Oxyuris vermicularis, Salmonella-enteritidis and actinomycosis (one case each) and appendicular carcinoma (2 cases) are described in more detail. Attention is called to the aetiology, pathogenesis and treatment of these rare causes of appendicitis.

[Appendicitis: microbial interactions and new pathogens]

The Authors present an exhaustive review on microbial agents of appendicitis by means of literature and personal research data. Thus, a detailed analysis is made on common autochthonous agents and their pathogenetic interactions and on less common exogenous bacterial, viral, mycotic, protozoan and helminthic agents with emphasis to the role of Yersinia enterocolitica. In fact this bacterium seems responsible for 3% to 8% of cases in accordance with literature and personal research data (more detailed, Y. enterocolitica has been isolated in 3.8% of 208 inflamed appendices from both pediatric and adults surgical florentine patients). At the end, the pathogenetic role of "new" other bacteria, like Buttiauxella agrestis, Aeromonas hydrophila, Arizona, Streptococcus lactis, is debated on the basis of a personal study.

Schistosomiasis of the appendix

The clinicopathological features of schistosomiasis of the appendix are discussed, based on the clinical presentation, operative findings and morphological changes in the specimens of patients seen in Ibadan between 1980 and 1989. Schistosoma haematobium was implicated as the causal agent of a granulomatous inflammatory reaction with eosinophilia and fibrosis. Intramuscular oviposition was associated with frank acute appendicitis, and serosal involvement resulted in peritoneal adhesions, with ileoileal intussusception in one patient. The actual role of schistosomal infestation as a contributory factor in appendicitis is still open to debate, but the diagnosis must be entertained in patients in the tropics with features of acute appendicitis or recurrent abdominal pain.

[Entamoeba histolytica stained with Warthin-Starry stain]

The Warthin-Starry stain have been used for coloring a different microorganism like spirochetas, Donovan bodies and Campylobacter and also melanin granules demonstration in soft tissues tumors. We started using the stain, as we know it, in order to stain the Histolytica amebas. We observed parasite stained black and brown as well as a good differentiation between endoplasm and ectoplasm where granular appearance, bacterial remnants and red cells were apparent. The stain was also usefull in differentiating amebas from histiocytes. We advice its use in amebiasis since is inexpensive and easy to do.

Sex, Enterobius vermicularis and the appendix

Examination of 182 appendices containing Enterobius vermicularis demonstrated that male pinworms are seen more commonly than female. There was no association between the sex of pinworms and inflammation in the appendix but inflammation was frequently seen in association with luminal ova. Ova release from female pinworms may be a feature of appendiceal obstruction.

Mast cell numbers in appendices with threadworm infestation

A study has been made of mast cells (MC) in surgically resected appendices using a long toluidine blue (LTB) staining method. The numbers of MC in measured areas of both mucosa and submucosa/muscularis were counted and comparisons made between 22 appendices containing threadworms and 22 which were histologically normal. There was considerable variation in MC numbers from case to case and the patients aged under 15 as a group had a higher mean number of mucosal MC than the older patients. The reasons for the high individual variation could not be identified from the histological sections, and no correlation was found between MC numbers and the presence of threadworms.

The radiographic evaluation of appendiceal calcification due to schistosomiasis

In a 6-month period, 25 appendices with histological involvement by schistosomiasis were radiographed. Eleven showed varying degrees of radiographically detectable calcification having a spotty, linear, or amorphous pattern affecting either a short segment or the whole appendix. Four of these appendices had a mixed pattern and one also had nodular calcification in the mesoappendix. In only 1 patient was the appendiceal calcification visible on preoperative abdominal radiographs. In 5 asymptomatic patients, not submitted to surgery, appendiceal calcification was detected during radiologic evaluation of urinary schistosomiasis.

Appendiceal schistosomiasis. Method of classifying oviposition and inflammation

Twenty surgical specimens of appendiceal schistosomiasis were reviewed retrospectively. They constituted 1 percent of 1984 appendices seen among approximately 15,000 surgical specimens examined at free central laboratories serving the Igbos of Nigeria, West Africa. Oviposition by Schistosoma haematobium was classified according to its association with suppurative appendicitis and normal appendices. Seven of ten infested appendices obtained at curative operations showed suppurative appendicitis, whereas eight of nine infested appendices removed at incidental appendectomies were negative. One interval appendectomy was also negative. It is postulated that utilization of this novel classification on a worldwide basis will help to end the controversy concerning the etiologic role of schistosome ova in acute appendicitis.

Acute intestinal obstruction from a granuloma due to Schistosoma hematobium in the appendix

A case of acute intestinal obstruction due to a granuloma caused by Schistosoma haematobium in the appendix is presented. The patient came from a pure S. haematobium area and only S. haematobium eggs were identified. The granuloma turned the appendix into a cingulum that caused an intestinal strangulation.