The Simultaneous Occurrence of Acute Appendicitis and Bowel Perforation in Taenia Infection: A Case Report

Abstract

Background: Appendicitis is most likely due to obstruction of the appendiceal lumen. Parasitosis is an unusual cause of obstruction and in specific, Taenia Saginata is a very rare cause of appendicitis, even more so of small bowel perforation. Teiniosis is usually an asymptomatic process but a greater load or migration of the adult form may complicate some cases. The simultaneous occurrence of acute appendicitis and ileal perforation in the same setting has not been reported in the literature. Case Presentation: A 60-year-old Lebanese female patient presented to the emergency department with right lower quadrant pain radiating to the left lower abdomen. The patient reported associated fever, chills, and anorexia prior to presentation. On physical examination, she was afebrile and normotensive, abdominal examination revealed diffuse lower abdominal tenderness. A blood workup revealed an elevated c-reactive protein (CRP) value with a normal white blood count (WBC). Computed tomography (CT) scan done with intravenous (IV) and per os (PO) contrast disclosed a leak of PO contrast in the absence of pneumoperitoneum implying a contained perforated appendicitis or colitis. The patient underwent urgent laparoscopic exploration. Intraoperatively patient had gangrenous appendicitis and an inflamed right fallopian tube, as well as small bowel perforation and the presence of a tapeworm. The tapeworm was removed and the patient ended up having an appendectomy, right salpingectomy, and oophorectomy, with the closure of ileal perforation. Her hospital stay was uneventful and she was discharged on ciprofloxacin, mebendazole, and metronidazole. Soon after her discharge from the hospital, the patient resumed her normal daily activities. Histopathological studies revealed mixed inflammatory infiltrates and the worm to be Taenia Saginata. Conclusion: Patients with teniosis are mostly asymptomatic. In symptomatic patients, the course is usually mild except for some rare occasions including appendicitis or bowel perforation. The diagnosis of Taenia Saginata infection in such cases should be considered in endemic areas such as the Middle East and North Africa (MENA) region where eating raw meat is habitual.