Atypical Appendicitis: Schistosomal Infection Causing Perforated Appendicitis.

Abstract

Appendicitis is the most common cause of surgical abdomen, with various unusual presentations. We present a case report of acute appendicitis secondary to Schistosomal infestation. We have reviewed the literature to comprehend the microbiology and the specific interventions needed for the management of this condition. Schistosomal infestation is a common tropical disease, but in view of extensive emigration and globalization, the incidence is increasing in the US and other western countries. Even though rare, it is still important to understand the natural history and know how to treat this disease. The patient was a 24-yearold female patient who emigrated from Liberia. She presented to the emergency room with abdominal pain. The clinical examination and imaging demonstrated acute perforated appendicitis. Emergency appendectomy was performed. The patient recovered uneventfully and was discharged the next day. The pathology report revealed acute suppurative appendicitis with numerous calcified parasites, consistent with Schistosomiasis. The patient was seen in the clinic the following week and appropriate treatment with Schistosomial antimicrobials was recommended. In this case report we reviewed the literature to give a synopsis of pathogenesis, microbiology and the management of Schistosomal appendicitis. We recommend having Schistosomal infection in the differential diagnosis of appendicitis, especially in patients from endemic areas or travelers from endemic areas.