Identification of parasitic infections in appendectomy specimens using histopathological and faecolith examinations

Abstract

Background Appendicitis is the most common acute surgical condition of the abdomen, and appendectomy constitutes one of the most common surgical operations worldwide. Gender, age, seasonal variation and leucocytic count have been investigated in many studies, however, causative parasitic agents of appendicitis are the most important. They differ from country to country. Objective The present study aimed to investigate parasitic infections as causes of appendicitis among patients attending Minia University Hospital, Minia Governorate, EL Minia, Egypt. Methodology This descriptive study was carried out during the period between October 2013 and March 2014. Among 100 patients treated by appendectomy with a prediagnosis of appendicitis, 55 were males and 45 were females. All patients with clinically prediagnosed appendicitis were subjected to an open appendectomy, in which a right Macberny incision was made, followed by delivery of the caecum, devascularisation of the appendix, base ligation and appendectomy. Removed appendices were preserved in 10% formalin, fixed, sectioned, stained with H & E and examined for histopathological changes and presence of parasites. The faecolith contents of the remaining portions of appendices were evacuated. A wet mount preparation from each specimen was subjected to light microscopic examination for detection of parasites. Results Parasitic infection was detected in nine appendectomy specimens. The presence of Enterobius vermicularis worms was confirmed in three cases by both histopathological and faecolith examinations. Eggs of Ascaris lumbricoides , Ancylostoma duodenale and Hymenolepis nana were detected in one case each by faecolith examination. Bilharzial granulomas were detected in three cases by histopathology. Interestingly, E. vermicularis and the eggs of A. lumbricoides , A. duodenale and H. nana were found to be associated with obstructive acute appendicitis, whereas bilharzial granulomas were observed in chronic appendicitis. Conclusion The study concluded that parasitic infections constitute only 9% of the surgically removed appendices. Schistosoma spp . and E. vermicularis were the most common parasitic recorded. The association of H. nana with acute appendicitis appears to be a novel finding. A combination of histopathology and faecolith examinations is necessary for detection of parasitic causes of appendicitis.