Pelvic Pain in a Reproductive-Age Woman Caused by Enterobial Infection of the Appendix

Background: Lower abdominal and pelvic pain frequently has nongynecologic causes, and diagnosis and treatment could be challenging. While gynecologic causes are common, careful consideration must be given to other etiologies as well, particularly gastrointestinal causes. The appendix is a frequent culprit. Even in the absence of gross appendicitis, the appendix can be a cause of chronic lower abdominal pain. The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion stating that elective coincidental appendectomy during a gynecologic surgery may be beneficial in some circumstances. Case: A was a 43-year-old, gravida 6, para 6 woman underwent uncomplicated total vaginal hysterectomy and bilateral salpingectomy for abnormal uterine bleeding. Five weeks postoperatively, she developed right lower-quadrant (RLQ) pain of unclear etiology. Her symptoms did not respond to conservative management. She was taken back to the operating room for examination under anesthesia and diagnostic laparoscopy, at which time, no gynecologic etiology was found. Elective appendectomy was performed for the RLQ pain. Results: This patient's pain resolved. Pathologic examination of her appendix showed it contained an adult pinworm (Enterobius vermicularis). The patient and her close contacts were treated with albendazole. Conclusions: Gynecologists should consider atypical appendiceal pathology, including helminthic infections, in the differential diagnosis of chronic and subacute lower abdominal and pelvic pain. (J GYNECOL SURG 36:141)