PDF(Pubmed)
Abstract：
Background: The role of Enterobius vermicularis infestation in the context of appendicitis is largely overlooked, but Enterobius vermicularis is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of Enterobius vermicularis findings in appendectomies and to evaluate the clinical and histopathologic features of patients with Enterobius vermicularis-associated acute appendicitis and those with appendiceal Enterobius vermicularis infestation. Methods: The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with Enterobius vermicularis on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. Results: The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with Enterobius vermicularis infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); p = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); p = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) p = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) p < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; p = 0.003) and less frequent vomiting (12.5% vs. 47.6%; p = 0.004) compared to the patients with Enterobius vermicularis-associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein (p = 0.009), White blood cells (p = 0.001) and neutrophils (p < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had Enterobius vermicularis infestation than in those with Enterobius vermicularis-related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); p = 0.040). Conclusions: Pediatric surgeons should consider Enterobius vermicularis infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict Enterobius vermicularis infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy.
摘要：
背景：在阑尾炎的背景下，Vermicularis感染的作用在很大程度上被忽视，但疣状肠杆菌被认为是意外且重要的阑尾切除术发现。这项研究的目的是调查阑尾切除术中蠕虫的发现频率，并评估与蠕虫相关的急性阑尾炎和阑尾蠕虫感染的患者的临床和组织病理学特征。方法：回顾性分析了2009年1月1日至2024年1月1日在克罗地亚两个大型儿科中心接受阑尾切除术的所有儿童的病历。6359例阑尾切除术中，61例（0.96％）儿童在组织病理学上被诊断为蠕虫肠球菌，并纳入进一步分析。比较了这些群体的人口统计学特征，实验室值，临床特征和组织病理学发现。结果:肠道病的发病率在个体研究年份略有波动,但总体上是恒定的。所有患者的中位年龄为11岁（IQR8.5，13），女性占主导地位(60.7%)。在34％的阑尾物种中观察到急性阑尾炎。坐骨草虫感染的患者，没有阑尾炎,年轻（9岁（IQR8，13）vs.12年(IQR10，15)；p=0.020)，症状持续时间较长(36小时(IQR，12，48）vs.24小时(IQR，12、36)；p=0.034)，较低的体温（37°C（IQR36.8，37.4）与37.6°C(IQR,37，38.6)p=0.012)，较低的阑尾炎炎症反应（AIR）评分（3（IQR2，5）与7(IQR5，9.5)p<0.001)，回弹压痛发生率较低(57.1%vs.20％；p=0.003）和较不频繁的呕吐（12.5％与47.6％；p=0.004）与蠕虫肠球菌相关性急性阑尾炎患者相比。实验室中的急性炎症标志物在急性阑尾炎患者组中显示出明显更高的值：C反应蛋白（p=0.009），白细胞（p=0.001）和嗜中性粒细胞（p<0.001）。在任何一组中均未发现嗜酸性粒细胞增多，尽管与蠕虫相关的阑尾炎患儿的嗜酸性粒细胞计数显着高于与蠕虫相关的阑尾炎患儿（2.5％（IQR，4.3）与1.8%（IQR0.7，2.1）；p=0.040）。结论：小儿外科医师在切除阑尾时，应将疣肠病侵染作为鉴别诊断。年龄更小,症状持续时间较长，降低体温，较低的空气分数，阑尾较小直径和正常的实验室炎症标记物可以预测出现右髂窝疼痛的儿童的蠕虫肠杆菌感染，并避免不必要的阑尾切除术。
