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Presented by Ralph Hruban, M.D. and prepared by Angelique W. Levi, M.D.
Case 1: This one-year-old male presented with signs and symptoms of abdominal distress.
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1. Question
Week 43: Case 1
This one-year-old male presented with signs and symptoms of abdominal distress. An appendectomy was performed./images/6.4.01.RHHcase1a.jpg
/images/6.4.01.RHHcase1b.jpg
/images/6.4.01.RHHcase1c.jpgCorrect
Answer: Enterobius vermicularis
Histology: This cross-section of the appendix reveals an intraluminal parasite. The parasite is morphologically consistent with Enterobius Vermicularis.
Discussion: Enterobius vermicularis, more commonly known as “pin worm,” is a common inhabitant of the gastrointestinal tract. The adult parasite is a small white nematode measuring 8-13 mm in length. The adult worm lives in the lumen of the colon in humans and humans are the only natural host for this parasite. The female nematode migrates to the anus where it deposits its eggs on the perineal skin. This results in intense puritis and the patient then scratches the area facilitating the anal-oral transmission of the eggs. The eggs then hatch in the duodenum and, in general, remain intralumenal. In general, there is not a tissue phase of the organism, however, organisms in addition to being found in the lumen of the appendix have been reported in association with endometriotis, and even in the parenchyma of the lung.
Incorrect
Answer: Enterobius vermicularis
Histology: This cross-section of the appendix reveals an intraluminal parasite. The parasite is morphologically consistent with Enterobius Vermicularis.
Discussion: Enterobius vermicularis, more commonly known as “pin worm,” is a common inhabitant of the gastrointestinal tract. The adult parasite is a small white nematode measuring 8-13 mm in length. The adult worm lives in the lumen of the colon in humans and humans are the only natural host for this parasite. The female nematode migrates to the anus where it deposits its eggs on the perineal skin. This results in intense puritis and the patient then scratches the area facilitating the anal-oral transmission of the eggs. The eggs then hatch in the duodenum and, in general, remain intralumenal. In general, there is not a tissue phase of the organism, however, organisms in addition to being found in the lumen of the appendix have been reported in association with endometriotis, and even in the parenchyma of the lung.
