Guest GI Photo Quiz
After a few weeks' respite from our overindulgence in the fecal arts, which may have nearly killed the blog, I can present to you a case that is worthwhile. This was sent to me from my friend who is a new gastroenterology fellow in New York who made this finding while learning to drive the colonoscope a few weeks ago.
JD: This is a 65 year old white man with past medical history of only hypertension who was in for screening colonoscopy. He is a retired firefighter and has been married for 40 years. He has 4 children and 8 grandchildren, and has lived in New York, all of his life. He has not traveled, and denies any unusual foods. These photos were taken in the right colon at approximately 11:00 AM. The patient was asymptomatic. What is the most likely diagnosis and treatment?
4 Comments:
pinworms
vermox
The pinworm (Genus Enterobius) is a parasitic roundworm of the phylum Nematoda. The best known is the human pinworm, also known as the threadworm Enterobius vermicularis. It is found worldwide and causes the common infection enterobiasis in humans. The adult pinworm male is 1–4 mm in length, while the adult female is 8–13 mm and possess the long, pin-shaped posterior end for which the worm is named......Click to finish the article from Wikipedia.
JD:
Yeah, its a pinworm. A few of his grandchildren had pinworms and he was infected from them.
The life cycle of the parasites are so interesting. The pinworm life cycle is pretty simple. They are ingested by fecal-oral contact, the eggs hatch in the duodenum, the larvae molt a couple of times on their way down to the cecum and ascending colon where they mate. Gravid females migrate to the anus at night where they release their eggs and maybe cause some pruritis ani. Superinfection may occur from there and the "scotch-tape test" may catch them for diagnosis. You guys nailed it, the treatment is mebendazole 100mg po once.
Its a good thing the guy we scoped had some versed on board to make him forget everything he saw during the procedure.
Here in the Philippine General Hospital, almost every child in the Pediatrics wards has pinworms. Enterobius vermicularis.
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