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Issue Year : 2007, Issue Number : 2, Issue Month : June
Written By : Urwa Sarwar, Shahid Jamal, Azhar Mubarik, Mumtaz Ahmed Ahmadani
Belongs To : AM College Rawalpindi, Foundation Medical University Rawalpindi
ENTROBIOUS VERMICULARIS INFESTATION OF FALLOPIAN TUBE REPORT OF A CASE AND REVIEW OF LITERATURE
Article
Introduction
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.

Discussion
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.
Reference
1.      Siddiqui MI, Bilqees FM, Iliyas M, Parveen S. Prevalence of parasitic infection in a rural area of Karachi, Pakistan. J Pak Med Assoc 2002; 52: 315-20.
2.       Erhan Y, Zekioglu O, Ozdemir N, Sen S. Unilateral salpingitis due to enterobius vermicularis. Int J Gynae Pathol 2000; 19: 188-9.
3.       Tandan T, Pollard AJ, Money DM, Scheifele DW. Pelvic inflammatory disease associated with enterobius vermicularis. Arch Dis Childhood 2002; 86: 439-40.
4.      Rosai J. Gross techniques in surgical pathology. In: Ackerman’s surgical pathology. Singapore: Year book; 2004; 9.
5.      Waqar SN, Hussain H, Khan R et al. Intestinal parasitic infection in children from northern Pakistan. Infect Dis J 2003; 12: 73-7.
6.      Imran AA, Majid S, Khan SA. Morphological variation in appendicectomy specimens. Pak J Pathol 2005; 16: 58-60.
7.      Khan JS, Steele RJ, Stewart D. Entrobius vermicularis infestation of the female genital tract causing generalized peritonitis. Case report. Br J Obst Gynae 1981; 88: 681-3.
8.      McMahon JN, Connolly CE, Long SV, Meehan FP. Enterobius granulomas of the uterus, ovary and pelvic peritoneum..Two case reports. Br J Obst Gynae 1984; 91(3): 289-90.
9.      Sinniah B, Leopairut J, Neafie RC et al. Entrobiasis: a histopathological study of 259 patients. Am Trop Med Parasitol 1991; 85: 625-35.
10. Chandrasoma PT, Mendis KN. Enterobius vermicularis in ectopic sites. Am J Trop Med Hyg 1977; 26: 644-9.
11. Pletcher JR, Slap GB. Pelvic inflammatory disease. Pediatr Rev 1998; 19: 363-7.

 
 
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