Schistosomiasis: A Rare Cause of Acute Appendicitis in the African American Population in the United States

Abstract

Schistosomal appendicitis is rarely reported in developed countries. In this article we report a case series of schistosomal appendicitis at our community teaching hospital. In this retrospective study, we conducted a thorough database search for schistosomiasis in patients who had undergone appendectomy for acute appendicitis from 1995 to 2005. Of 1690 total appendectomies performed during this period, three cases of schistosomal appendicitis were identified. Data obtained included patient demographics, laboratory investigations, and pathological specimen. All patients belong to the African American race, are between the ages of 20 and 40 (mean 29.3 ± 9.5) years, and had onset of symptoms <24 hours in duration. Sudden onset of right lower abdominal pain with leucocytosis (14.1 ± 1.4 x 10³) is a common feature. All patients underwent appendectomy and each was found to have an enlarged and inflamed appendix intraoperatively. Histopathology revealed transmural inflammation predominantly with neutrophils and scanty eosinophils. Schistosomal granulations are present in all layers of appendix including serosa. All patients had an uneventful postoperative recovery. Schistosomal appendicitis is an uncommon condition especially in developed countries like the United States. However, with recent changes in global migration, schistosomiasis should be considered as one of the causes for appendicitis, especially in the African American population.