Sodergren Mikael H, Jethwa Paras, Wilkinson Simon, Kerwat Rajab
Department of Surgery, Queen Mary's Hospital, Sidcup, Kent, UK.
Scand J Gastroenterol. 2009;44(4):457-61. doi: 10.1080/00365520802624227.
Enterobius vermicularis (pinworm) infestation can present with symptoms resembling acute appendicitis, although current evidence suggests that it does not necessarily cause acute appendicitis. The purpose of this study was to characterize the clinical presentation of patients with pinworms in the vermiform appendix and to establish features suggestive of this condition.
A retrospective analysis of all patients undergoing appendicectomy with appendicular pinworms between 1998 and 2003 was undertaken. Patients were compared against 54 controls with confirmed acute suppurative appendicitis from the same time period. Presenting features, vital signs and modified Alvarado scores were obtained from the patients' records.
Eighteen out of 1150 patients (1.5%) undergoing appendicectomy were proven to have pinworms (age range 8-37 years, 12 F, 6 M). Two of 18 appendices containing pinworms showed evidence of inflammation. Patients with pinworms had significantly lower white cell counts (WCCs) than the control group (median 8.9 versus 14.7, p=0.045), lower total Alvarado scores (median 5.5 versus 7, p=0.01) and were more likely to have had recurrent episodes of right iliac fossa (RIF) pain and previous hospital admissions (p<0.001).
E. vermicularis infestation of the appendix should be considered in the differential diagnosis of patients who present with recurrent RIF pain but do not have a significantly raised WCCs, or high Alvarado scores. These patients should be investigated with early fecal sampling and night-time application of cellophane tape, and they may benefit from empirical antiparasitic treatment.
蛲虫感染可表现出类似急性阑尾炎的症状，尽管目前证据表明其不一定会引发急性阑尾炎。本研究旨在描述阑尾中有蛲虫的患者的临床表现，并确定提示该病症的特征。
对1998年至2003年间所有接受阑尾切除术且阑尾中有蛲虫的患者进行回顾性分析。将这些患者与同期确诊为急性化脓性阑尾炎的54名对照组患者进行比较。从患者记录中获取其临床表现、生命体征和改良的阿尔瓦拉多评分。
1150例接受阑尾切除术的患者中有18例（1.5%）被证实有蛲虫（年龄范围8 - 37岁，女性12例，男性6例）。18个含有蛲虫的阑尾中有2个显示出炎症迹象。有蛲虫的患者白细胞计数（WCC）显著低于对照组（中位数8.9对14.7，p = 0.045），总阿尔瓦拉多评分更低（中位数5.5对7，p = 0.01），并且更有可能有右下腹（RIF）疼痛反复发作和既往住院史（p < 0.001）。
对于出现右下腹反复疼痛但白细胞计数未显著升高或阿尔瓦拉多评分不高的患者，在鉴别诊断时应考虑阑尾蛲虫感染。这些患者应尽早进行粪便采样和夜间应用透明胶带检查，经验性抗寄生虫治疗可能对他们有益。
