A 20-year-old woman presented with abdominal pain and MRI findings of intussusception of the distal small bowel with no identifiable lead point and no visualisation of the appendix. A diagnostic laparoscopy succeeded in manually reducing the intussusception but was unable to find any candidate lead point. Intraoperatively, hyperperistalsis was observed throughout the small bowel which seemed prone to transient intussusception. Incidental appendectomy revealed an uninflamed appendix with Enterobius vermicularis (pinworm) infestation, the most common parasite present in appendectomy specimens worldwide. Although intussusception in young adults is an uncommon occurrence, the unique nature of this case is amplified by the concurrent finding of E. vermicularis infection of the appendix in an adolescent in western Canada, a phenomenon normally observed in paediatric populations with higher incidence in tropical areas. Although the mechanism of intussusception in this patient remains unclear, it is hypothesised that E. vermicularis colonisation acted as an irritant stimulating intestinal hypercontractility with resulting intussusception. Successful medical eradication of the pinworm in this individual may prevent future recurrence.
- infection (gastroenterology)
- small intestine
- gastrointestinal surgery
- hepatitis and other GI infections
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CP and DY are joint first authors.
DE and HMY are joint senior authors.
DE and HMY contributed equally.
CP and DY contributed equally.
Contributors CP and DY contributed equally as first authors to the gathering of patient information, review of the literature, constructing the first drafts of the manuscripts and subsequent revisions. HMY and DE contributed equally as second authors whereby they contributed substantially to the conception and design of the work, interpretation of data, creating critical revisions of the manuscript and providing final approval for the version published. DE and HMY contributed equally to this work as last co-authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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