A Journal of Army Medical & Dental Corps

Being published since 1956

ISSN (online) 2411-8842
ISSN (print) 0030-9648

VOL 57, No. 2, JUNE 2007


Urwa Sarwar, Shahid Jamal, Azhar Mubarik, Mumtaz Ahmed Ahmadani


Intestinal parasitic infections including enterobius vermicularis (pin worm or thread worm) infestation are quite frequent in our population [1]. Rarely it may invade the tissue with or without inflammatory reaction [2]. Although not very frequent but ectopic infections in female genital tract can be diagnostic challenge and may have long term effect on reproductive health [3]. We share our experience, to document one such case of worm infestation involving fallopian tube.
Case report

A 45 years old female presented to the Gynaecology out patient department, Military Hospital Rawalpindi with polymenorrhagia which was not responding to medical treatment. Routine investigations were within normal limits, except low Haemoglobin. As she had completed her family, hysterectomy was done and specimen was sent for histopathological examination to histopathology department Army Medical College, Rawalpindi, Pakistan. The routine sections of hysterectomy specimen were taken as described [4]. The sections were processed in automatic tissue processor (Sakura, Japan), embedded in paraffin and 3-5 micron thick sections were prepared. The sections were stained with Haemotoxylin & Eosin (H&E). Under microscope, the endometrium showed disordered proliferation. On examination of adnexa one of fallopian tubes showed cross section of the body of Enterobius Vermicularis without any significant inflammatory reaction around (fig).

Correspondence: Col Shahid Jamal, Associate Professor of Pathology, Army Medical College, Rawalpindi.

Parasitic infestations including Enterobius Vermicularis are very common intestinal parasite in our country affecting mostly young children [1,5]. It commonly infest intestines of all age groups; males, females and may even involve tissues of intestinal tract particularly appendix [6]. Its presence at ectopic sites is rather infrequent and its discovery even rarer. The internationally reported cases have stated it to be found at all levels of reproductive tract. The pathological effects produced by the parasite may results in an abscess (tubo ovarian), granulomata of vulva, vagina, uterus fallopian tubes and ovaries [7-9].
The exit of the worm from the fallopian fimbriae into the peritoneal cavity can even lead to pelvic or abdominal peritonitis or granulomatous infection of liver or spleen etc [10].
In our setup, the knowledge of such extraordinary route adopted by this common parasite might become useful in patients with
Fig:         Photomicrograph showing fallopian tube with cross section of the body of enterobius vermicularis (H&E x 400).
concurrent intestinal infestation and female genital tract pathology. The mother of the malady might just be cured with a very easy and cost effective antiparasitic treatment. Moreover this possibility should be suspected in an unresponsive patient who has already been treated with other medications and sexually inactive young girls presenting as pelvic inflammatory disease (PID) [3]. Such PID in young/paediatric patients may be primarily due to worm infestation or with superadded bacterial infections [3,11].
The purpose of reporting this case is that, considering quite frequent parasitic infestation in our population such possibility should be kept in mind particularly in paediatric patients and young, sexually inactive girls, presenting as PID.


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