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Whipworm Found During a Colonoscopy

Wang, Xiao Jing MD1; Eaton, John E. MD1

doi: 10.14309/crj.0000000000000259
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1Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN

Correspondence: Xiao Jing Wang, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Wang.xiao@mayo.edu).

Received May 10, 2019

Accepted September 23, 2019

Online date: October 22, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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CASE REPORT

A 78-year-old man underwent a surveillance colonoscopy after a previous large polypectomy. He was otherwise healthy and had no concerning symptoms. He had recently traveled to South Africa and Thailand. He had a remote history of traveling to East Africa as a member of the Peace Corps. During the colonoscopy, a worm measuring 2 cm in length was found in the ascending colon affixed to the mucosa (Figure 1). En bloc resection was undertaken with a Roth net. On attempted removal, the worm was found to be firmly affixed to the mucosa (Figure 2). The worm was submitted en bloc, without fixation, to the microbiology department. Examination of the specimen revealed the glandular stichosome around the anterior esophagus, diagnostic of an adult female Trichuris trichiura (whipworm).

Figure 1

Figure 1

Figure 2

Figure 2

T. trichiura is the third most common roundworm infection in humans, frequently found in subtropical and tropical regions. Transmission is fecal-oral with humans as the principal host. Adult worms live in the cecum and ascending colon, with their anterior portions threaded into colonic mucosa (Figure 2). Females deposit up to 20,000 eggs per day which are shed in the stool. Infection is largely asymptomatic, but heavy infections can cause abdominal pain, anorexia, diarrhea, or rectal prolapse.1

The literature on infections in endemic regions show that colonoscopy is superior to stool ova and parasite examination for diagnosis as eggs were only seen in 2.7%–6.4% of cases where colonoscopy revealed a worm.2,3 In a review of over 4,000 patients, 82% of patients were treated with endoscopy removal of worms alone.2 If needed, treatment options include albendazole, mebendazole, and ivermectin.1

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DISCLOSURES

Author contributions: XJ Wang wrote the manuscript and is the article guarantor. JE Eaton revised the manuscript.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

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REFERENCES

1. Centers for Disease Control and Prevention. Parasites - Trichuriasis (also known as whipworm infection). 2013. https://www.cdc.gov/parasites/whipworm/index.html. Accessed October 16, 2019.
2. Wang DD, Wang XL, Wang XL, Wang S, An CL. Trichuriasis diagnosed by colonoscopy: Case report and review of the literature spanning 22 years in mainland China. Int J Infect Dis. 2013;17(11):e1073–5.
3. Jha AK, Goenka MK, Suchismita A. Clinical correlates of trichuriasis diagnosed at colonoscopy. Indian J Gastroenterol. 2017;36(5):420–3.
© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.