Enterobius vermicularis infection at time of appendicectomy: is it a neglected risk factor?

Abstract

Obstruction of the appendiceal orifice is well established as a potential cause of appendicitis. However, it remains debated as to if appendiceal orifice obstruction secondary to Enterobius vermicularis is considered a risk factor for appendicitis or appendiceal colic. Enterobius vermicularis maintains an increased prevalence within lower socioeconomic and human development index regions. Whilst Australia has an overall high human development index it has significant variability in health literacy and socioeconomics. The purpose of this literature review is to evaluate the relationship between Enterobius vermicularis and appendicitis, to review the prevalence of Enterobius vermicularis appendicectomies in lower human development index and socioeconomic status communities, and to review the Australian based Enterobius vermicularis literature available. A comprehensive review of the literature was performed to review the prevalence of Enterobius vermicularis at time of appendicectomy. PubMed, Scopus, and Google Scholar databases were investigated for applicable studies published until December 2023. Enterobius vermicularis within the appendiceal lumen may cause irritation and lymphoid hyperplasia resulting in appendiceal colic with a similar clinical presentation to that of acute appendicitis. An increased association between Enterobius vermicularis, low human development index, and socioeconomic status is suggested. Public health interventions reduce Enterobius prevalence. A single Australian based study from 1994 was identified. Enterobius vermicularis infection is a neglected risk factor for appendiceal colic. A high index of suspicion for Enterobius vermicularis infection should be taken for clinically stable patients with normal inflammatory biochemistry and low human development index. Further research is required to assess if there is a disparity in Enterobius vermicularis in relation to human development index, socioeconomic status, and remoteness within Australian communities.