Pelvic abscess from enterobius vermicularis. Report of a case with cytologic detection of eggs and worms.

BACKGROUND: Enterobius vermicularis is known to produce perianal and ischioanal abscesses and invade the peritoneal cavity via the female reproductive system, causing pelvic peritonitis. However, there are only rare case reports on the cytodiagnosis of these parasitic lesions. CASE: A 28-year-old woman was admitted with a tender left iliac fossa mass and greenish vaginal discharge. Ultrasonogram and computed tomography scan confirmed the presence of a mass lesion suggestive of a tuboovarian abscess. Cytologic examination of the pus obtained during left salpingo-oophorectomy revealed the presence of ova of E vermicularis and fragments of the adult worm in an inflammatory exudate consisting predominantly of neutrophils, eosinophils and occasional epithelioid cell granulomas. Paraffin sections of the tuboovarian mass showed necrotizing epithelioid cell granulomas, but neither ova nor any worm section was identified. Although the possibility of tuberculosis was considered histologically, Ziehl-Neelsen (Z-N) stain for acid-fast bacilli was negative. Z-N staining of the smear and mycobacterial culture of the pus also did not yield positive results. CONCLUSION: E vermicularis may cause tuboovarian abscess with necrotizing epithelioid granulomas mimicking tuberculosis. Cytologic examination of the pus is helpful in the diagnosis.

Hemorrhoidectomy and sphincterotomy. A prospective study comparing the effectiveness of anal stretch and sphincterotomy in reducing pain after hemorrhoidectomy.

The effectiveness of two maneuvers, anal stretch (group 1) and sphincterotomy (group 2), were evaluated in reducing posthemorrhoidectomy pain. The study included 133 patients in group 1 and 125 patients in group 2. Immediate follow-up results showed that 18.4 percent of patients in group 2 required narcotic analgesics in the first 24 hours as compared with 100 percent of group 1 patients (P less than .01). Urinary retention developed in 4 percent of the patients in group 2 and 39 percent of the patients in group 1 (P less than .01). Pain associated with the first postoperative motion was severe in 96.2 percent of those in group 1 as compared with 6.4 percent of patients from group 2 (P less than .01). Moreover, long-term follow-up showed that 57.3 percent of group 1 patients continued to suffer from fecal soiling for ten weeks as compared with 6.4 percent in group 2 who suffered only 4.5 weeks (P less than .01). The routine performance of sphincterotomy through one of the hemorrhoidectomy wounds significantly reduced posthemorrhoidectomy pain and complications.