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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