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A 33-year-old woman presented to the emergency department with intermittent lower abdominal pain on the right side. She had no associated fever, vomiting, or diarrhea and had no history of recent travel. The physical examination showed tenderness in the right lower abdominal quadrant, as well as in the suprapubic area and right flank, without guarding or rebound tenderness. Laboratory testing showed a leukocyte count of 15,000 per cubic millimeter (reference range, 4000 to 10,000), a neutrophil count of 13,000 per cubic millimeter (reference range, 2500 to 7000), and a normal eosinophil count. A computed tomographic scan of the abdomen showed thickening of the appendix without evidence of fecalith or perforation. A laparoscopic appendectomy was performed. During the surgery, worms were seen emerging from the appendiceal stump after removal of the appendix (see video). Histologic analysis identified Enterobius vermicularis. Infection with the parasitic worm E. vermicularis typically causes perianal pruritus. The worm can migrate, causing urinary and genital tract infections. The patient was treated with albendazole after surgery, and she had no complications or recurrence at follow-up 1 year later.



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