Acute appendicitis coexisting with caecal perforation caused by Ascaris lumbricoides: a surgical enigma

Abstract

Ascaris lumbricoides infestation is one of the most common helminthic infections worldwide, particularly in low- and middle-income countries with poor sanitation. Although it has been implicated in several abdominal surgical emergencies, the concurrent occurrence of acute appendicitis and caecal perforation caused by Ascaris lumbricoides is exceedingly rare and has been infrequently reported in literature. We report the case of a 21-year-old female undergraduate who presented with a five-day history of migratory right lower abdominal pain, vomiting, and low-grade fever. Clinical evaluation was suggestive of acute appendicitis, and she underwent emergency open appendicectomy. Intraoperatively, copious peritoneal fluid, an inflamed vermiform appendix, and a pinhole caecal perforation approximately 5 mm from the appendiceal base were identified. An adult Ascaris lumbricoides worm was found protruding through the perforation. Appendicectomy, primary repair of the caecal perforation after freshening of the edges, and peritoneal lavage were performed. Histopathological examination confirmed acute inflammation of both the appendix and caecal tissue. The patient received postoperative antibiotics and albendazole, had an uneventful recovery, and was discharged on the fifth postoperative day. The coexistence of acute appendicitis and Ascaris lumbricoides-induced caecal perforation is an exceptionally rare surgical entity that may be diagnosed only at operation. In regions where helminthic infestations are endemic, surgeons should maintain a high index of suspicion for concomitant bowel pathologies and routinely inspect the caecum and terminal ileum during appendicectomy to avoid missed diagnoses and improve patient outcomes.