Appendicular Ascariasis; an unusual cause of unexplained pain abdomen

Abstract

Thirty year old female recently delivered by normal veginal delivery presented with pain lower abdomen of six days duration. Pain was intermittent and colicky, sometimes intractable enough and needed parenteral analgesia. She was admitted and evaluated in a peripheral health facility with CBC, KFT. LFT, urine examination, Ultrasonography abdomen and pelvis reported as normal. As patient persisted with pain abdomen she was referred for a gastroenterology opinion. She was admitted in gastroenterology unit for further evaluation. Her baseline investigation again were normal. Patient now started intermittent vomiting also. A gynecological opinion was also sought, who ruled out any gynecological cause of lower abdomen pain. By now she needed round the clock analgesia. Her upper GI endoscopy was normal. She was subjected to CT scan abdomen and pelvis which was normal. Patient developed few episodes of loose motions, possibly because she had taken lot of milk (without the knowledge of nursing staff) on advice of some non-medico. In view of new onset lower GI symptoms she was taken for colonoscopy. On colonoscopy a live ascaroid [Figure 1] was seen struggling across the appendicular opening. The worm was removed with forceps and retrieved outside the body. Patient developed instantaneous relief of pain and was discharged next morning. A week later she followed in OPD without any fresh or residual symptoms.