Enter your Email address:
Wolters Kluwer Health may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
You currently have no recent searches
Walia, Ritu*; Baker, Susan†; Khan, Abdul‡; Putnam, Theodore I†; Alkhouri, Naim*; Baker, Robert†
*Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
†Department of Pediatric Gastroenterology and Hepatology, USA
‡Department of Pathology, Buffalo Children's Hospital, Buffalo, NY, USA
A 17-year-old white male presented with a 4-day history of sharp, right lower quadrant (RLQ) abdominal pain, nausea, and vomiting. Findings from physical examination showed diffuse abdominal tenderness with guarding of the RLQ region. White blood cell counts with differential and liver enzymes were normal. Computed tomography of the abdomen was unremarkable. Because of worsening RLQ pain, he underwent laparoscopic appendectomy. The appendix was grossly normal; pathology is shown in Figure 1.
What is the most likely cause of appendicitis in this patient: (1) Fecolith, (2) Crohn disease, (3) Trichuris trichuria, or (4) Enterobius vermicularis?
Figure 1A shows mucosal inflammation with prominent eosinophils. E vermicularis was identified in the appendiceal lumen histologically; this organism is characterized by a prominent esophageal bulb and external spines called lateral alae (Fig. 1B). Although appendicitis is a common surgical disease in pediatric patients, parasites are rarely found associated with appendiceal inflammation. E vermicularis is the most common helminth responsible for appendicitis in children (1). Infestation of the appendix can produce clinical features of appendiceal colic (2). In a large pediatric series of 1549 appendectomies, E vermicularis was found in the appendix of 21 patients (1.4%) (3). Because appendectomy alone is not curative, the patient was treated with mebendazole and rapidly recovered. In summary, appendectomy specimens should be reviewed for the presence of eosinophilic infiltration and parasitic infection because pharmacologic eradication with antihelminthics is necessary in such cases following surgery (3).
The authors report no conflicts of interest.
Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.
© 2009 Lippincott Williams & Wilkins, Inc.
Colleague's E-mail is Invalid
Your Name: (optional)
Separate multiple e-mails with a (;).
Thought you might appreciate this item(s) I saw at Journal of Pediatric Gastroenterology and Nutrition.
Send a copy to your email
Your message has been successfully sent to your colleague.
Some error has occurred while processing your request. Please try after some time.
An Existing Folder
A New Folder
The item(s) has been successfully added to "".
Login with your LWW Journals username and password.
Username or Email:
Enter and submit the email address you registered with. An email with instructions to reset your password will be sent to that address.
Link to reset your password has been sent to specified email address.
What does "Remember me" mean?
By checking this box, you'll stay logged in for
days or until you logout. You'll get easier access to your articles, collections,
media, and all your other content, even if you close your browser or shut down your
To protect your most sensitive data and activities (like changing your password),
we'll ask you to re-enter your password when you access these services.
What if I'm on a computer that I share with others?
If you're using a public computer or you share this computer with others, we recommend
that you uncheck the "Remember me" box.
Save my selection
Visit JPGN.org on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.