Photo Rounds

Anorexia and stomach pain

A 21-year-old man from Mississippi had 3 days of anorexia and stomach pain. The day he went to see his family physician (FP), he’d developed a low-grade fever and was vomiting. The patient was tender at McBurney's point and had positive psoas and obturator signs. The FP admitted the patient to the local hospital, and his appendix was removed. (Resected appendix is shown.)

What's your diagnosis?


The image reveals Ascaris lumbricoides in the resected appendix—the cause of the acute appendicitis. While many Ascaris infections are asymptomatic, these large roundworms can obstruct the bowel and/or the appendix.

A lumbricoides is a common parasite in Africa and Central America, especially where the drinking water is not clean. This patient lived in rural Mississippi and would drink from local streams while fishing.

If detected before complications arise, A lumbricoides can be treated with a single oral dose of either albendazole 400 mg or mebendazole 500 mg. This patient recovered well from his surgery. He was treated prophylactically with mebendazole to eradicate any remaining roundworms.

Photo courtesy of James L. Fishback, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H. Intestinal worms and parasites. In: Usatine R, Smith M, Mayeaux EJ, et al. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:916-920.

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