| disease | Appendiceal Parasitic Disease |
| alias | Appendix Ascariasis, Schistosomiasis Appendicitis, Chronic Amoebic Appendicitis, Schistosomic Appendicitis, Chronic Amebic Appendicitis, Appendiceal Ascariasis |
Appendicitis caused by parasitic diseases is a common surgical acute abdomen. Many intestinal parasites can parasitize or enter the appendiceal lumen. For example, schistosomiasis-related appendicitis is frequently seen in schistosomiasis-endemic areas of southern China. In northern regions, appendiceal ascariasis is often observed, which is one of the complications of intestinal ascariasis. Amebic intestinal disease predominantly occurs in the cecum, with a higher likelihood of involving the appendix.
bubble_chart Pathogenesis
1. Schistosomal appendicitis: A chronic inflammatory process that may present with leukocyte infiltration, small mucosal ulcer formation. Prolonged stimulation can gradually lead to fibrosis, granuloma formation, or mucosal scar stenosis. Severe perivascular lesions may also impair the blood supply to the appendix. These pathological changes can serve as the pathological basis for the onset of acute appendicitis.
2. Appendiceal ascariasis: Ascaris worms typically parasitize the human ileum. Conditions such as diarrhea, deworming, pregnancy, etc., can cause abnormal intestinal motility and alter the intestinal environment. Additionally, Ascaris worms have a tendency to bore, allowing them to migrate into the cecum and enter the appendix, leading to appendiceal ascariasis. Once inside the appendiceal lumen, the worms can cause obstruction, and their movement can stimulate the appendix wall muscles, leading to spastic rigidity and potentially triggering acute appendicitis.
3. Chronic amebic appendicitis: Since amebic intestinal disease frequently affects the cecum, the appendix is often involved. Autopsies of colonic amebiasis cases reveal that 4.0%–6.2% exhibit amebic appendicitis, with some cases developing abscesses or perforation. Pure amebic appendicitis is rare. {|102|}
bubble_chart Clinical Manifestations1. Schistosomal appendicitis The symptoms of schistosomal appendicitis are the same as those of general acute appendicitis, but the course is rapid, the perforation rate is high, and the chances of residual abscess and intestinal fistula after surgery are also high. These characteristics should attract clinical attention.
2. Appendiceal ascariasis Abdominal pain is often paroxysmal colicky pain around the umbilicus, which is much more severe than the abdominal pain of general appendicitis. The migration of pain to the right lower abdomen occurs quickly and becomes fixed rapidly. Initially, there are intermittent periods of symptom relief between episodes of paroxysmal colicky pain, known as the spasmodic obstruction stage. If the obstruction is not relieved, the appendix becomes injured, leading to secondary infection and acute appendicitis, i.e., the inflammatory stage. Subsequently, the pressure inside the appendix increases, causing ischemia, necrosis, and perforation of the appendix wall. Ascaris worms may penetrate the abdominal cavity, causing severe suppurative peritonitis.
3. Chronic amebic appendicitis Recurrent right lower abdominal tenderness or persistent discomfort in the iliac fossa may occur, with acute episodes when accompanied by suppurative infection. The symptoms of this disease are similar to those of bacterial appendicitis and are often only discovered during surgery. The lesions are not limited to the appendix; the cecal wall also shows thickening and edema.
bubble_chart Auxiliary Examination
2. Appendiceal ascariasis: X-ray barium enema can reveal signs of appendiceal roundworms, and fiberoptic colonoscopy can confirm the diagnosis and remove the worms.
1. Schistosomal appendicitis has a high incidence of residual abscess and intestinal fistula after surgery, and these characteristics should draw clinical attention.
2. Chronic amebic appendicitis For patients suspected of having amebic appendicitis, anti-amebic drug treatment should be administered first before surgery. Handling the appendiceal stump during surgery is difficult, and postoperative appendiceal stump fistula is also prone to occur. Rash surgery may lead to the spread of lesions, formation of fecal fistula, or even death.
