Parasite infestation of the vermiform appendix: the experience in Kuwait

ABSTRACT

A histology-based retrospective study was carried out in Kuwait to determine the frequency and type of helminthic infestation of the appendix in this predominantly desert environment. In 1,674 consecutive appendectomies, 109 parasites [5.6%] of five species were detected Schistosoma sp. 70 [4.1%], Enterobius vermicularis 36 [2.1%], and a single case each of Ascaris lumbricoides, Taenia sp. and Trichuris trichiura. Schistosomiasis was seen exclusively in immigrants of whom 12 had evidence of coexistent extra-appendiceal infestation of the urinary system. Suppuration in this group was common [79%] in addition to fibrosis [74%] and granulomata [43%]. Enterobiasis seen in both natives and immigrants predominantly affected children. Suppuration in this group was uncommon [22%] but a fecalith or thick lumen contents containing the parasites were frequently seen [72%]. It was concluded that parasite infestation of the appendix is important to report even in countries such as Kuwait which is nonendemic for many intestinal parasites. Such data contribute to further understanding of epidemiology, enable the diagnosis of easily treatable disease such as enterobiasis, or provokes a search for more significant extra-appendiceal infection as in schistosomiasis. Enterobiasis should be suspected in children and young adults with normal histology of the appendix. Examination of the lumen contents may improve the chances of detecting intraluminal parasites