If Acute Appendicitis Due to Enterobius Vermicularis has Potential Predictive Differences in Terms of Blood Count Parameters Compared to Other Causes; Retrospective Study

Acute appendicitis is the most common cause of acute abdominal syndrome and the most frequent emergency operation in our country and all over the world. The main causes of acute appendicitis are; inflammation, fecaloid, tuberculosis, foreign body obstruction, tumor, diverticula and ‘enterobius vermicularis’ infection can cause this table formation. In this retrospective modified study, the possible predictive effects and differences of preoperative complete blood counts of enterobius vermicularis and acute appendicitis in patients who underwent appendectomy in acute appendicitis.

Keywords: Enterobius Vermicularis; Blood Count; Appendicitis

Appendectomy is one of the most common emergency surgical procedures and is the most frequently performed surgical oper- ation in the world and our country as acute abdominal surgery [1]. Addiss et al. found the risk of being appendicitis nearly 8.6% throughout life [2].In another study, it is noted that almost 7% of all people had an appendectomy operation during their lifetime [3]. The acute appendicitis, defined as the inflammation of the appendix, is mostly seen with the 2nd and 3rd decades [4]. His- topathological examinations of the specimens of patients who underwent appendectomy have been reported in studies are often infections such as acute inflammation, fibrous tissue, neoplasm, neuroendocrine tumors, tuberculosis, diverticulitis, granuloma- tous inflammation, adenomas, actinomycets, endometriosis and enterobius vermicularis [5]. The occlusion of the appendix lumen seems to be the reason for inflammation. The most common symptoms are abdominal pain (78%) and nausea-vomiting (26%) [6].

This study was constructed and applied in Eskisehir Osmangazi University general surgery department. Approximately 250 appendectomy surgeries are performed annually due to acute appendicitis at our center yearly. The operations can be performed open and laparoscopically. This study compared 21 patients who had undergone appendectomy surgery between 2012- 2017 whose pathologic examination was the main acute inflammation and 17 patients who had the same operation who had enterobius vermicularis in the final pathology. Reasons for inflammation in the control group were fecaloid, tumor, foreign body, neuroendocrine tumor and diverticulitis. As comparison parameter, full blood count values at the time of first application of the patients were used. Statistical analyzes were performed using IBM SPSS, version 21. The T test was assessed to normal range specimens and Mann-Whitney U used for abnormal range of specimens.

This study is designed whether a possible predictive effect of pre-operative complete blood count between patients who underwent objective appendectomy and reported as enterobius vermicularis and other group of patients.

Since the ‘Hb, Htc, erythrocyte and MPV’ variants showed normal distribution according to the distribution test (Table 1). T test was used to compare these variables with e.vermicularis and inflammation (other causative) patients (Table 2). Between 2012-2017, 38 patients undergoing appendectomy were analysed, divided into two groups (e.vermicularis-other). T test and Mann-Whitney U tests were used according to their variability or normal distribution of parameters (Table 3, 4 and 5). The results of the final evalua- tion revealed that the patients with enterobius vermicularis final histopathologic examination had statistically higher pre-operative initial blood counts than the other groups (Table 4).

Nonparametric Tests: The Mann-Whitney U test was used for nonparametric tests because the other variables were not normal distributions for RDW, LEUKOCYTE, ABS_NOTROFIL, ABS_LENFOSITE, AB_MONO, AB_EOZINE, AB_BAZO and PLT.

Acute appendicitis is the most common acute abdominal surgery worldwide. Obstruction of appendix lumen is seems to be the cause of appendiceal inflammation. Rare reasons such as fecalids, neoplasms, lymphoid hyperplasia are leading for obstruction [7]. Parasitic infections are common in South American countries. Parasitic infections are associated with poor hygienic conditions, low socioeconomic status, contaminant foods and contaminant water [8]. In recent studies, several cases of enterobius vermicularis that causes acute appendicitis are present all over the world. Enterobius vermicularis microorganism that spend lifetime in intestinal lumen is considered as an etiologic factor of acute appendicitis because of the ability of obstruction of the appendix lumen. In the case of acute appendicitis, physical examination, laboratory and ultrasonography triad is critical. In this process, pain in the lower right quadrant (Mc Burney point) and rebound in the examination are provided with laboratory tests. There is a critical advantage of the inflammatory parameters like wbc, sediments and CRP. Abdomen ultrasonography is the most commonly used imaging method in diagnosis in parameters of appendiceal inflammation, wall thickness, etc., but it can not provide definitive information about the etiologic reason for the naturality. Abdominal tomography can also be used in selected patients [9]. At the point our knowledge that routine blood counts were made in patients presenting with a complaint of abdominal pain and suspected of infection, we designed this retrospective study to analyse the possible predictive effect of parameters other than the most commonly used inflammatory markers (Wbc, sediments, CRP, neutrophil/lymphocyte ratio ...) of this whole blood count in determining whether acute appendicitis was caused by enterobius vermicularis or another cause during patient admission.

Main limitation fort his study was the average age of patients. Enterobius vermicularis caused acute appendicitis were diagnosed in young patients rather than elderly population.

As a result; absolute monocyte and plt (platelet) values should be considered in patients with acute appendicitis as a predictive factor for enterobius vermicularis infection except for the usual parameters. A good anamnesis and socioeconomic situation should be investigated in case of questioning whether antihelmintic medical therapy can suppress the evidence without needing surgery. This study should be designed and supported with studies in which the number literature is limited yet.