& descending colon without evidence of gangrene was noted. The patient was taken up for surgery – sentence to be deleted.  Sigmoid volvulus was de-rotated and decompressed using suction. The sigmoid colon, part of descending colon (suspecting gangrene) and appendix were resected after ligating the mesocolon.

Grossly, appendix with mesoappendix measured 4.5 cm in length, with an intact tip. Cut section showed a thickened wall with a small white thread-like structure protruding from the lumen.The colonic segment measured 30 cm in length with a dilated area of 8 cm seen from one surgical end. Cut section of the dilated segment showed flattening of mucosa with mild brownish discolouration. (Figure 2).

Figure 2a: The gross image of the appendix, inset shows threadlike structure - worm (arrow) Figures 2b and 2c: The gross image of external surface (2b) and cut surface (2c) of the colon showing flattening of mucosa in the dilated segment.

Microscopically, the lumen of the appendix showed a parasite morphologically resembling Enterobius Vermicularis along with faecal matter and features of subacute appendicitis.

underlying psychiatric illness.[2]. On literature search, reports mentioning the incidental finding of worms in cases of sigmoid volvulus have been documented. N Mourra et al [3]. have reported an unusual presentation of chronic intestinal schistosomiasis, masquerading as recurrent volvulus. In our case, we had a coincidental finding of Enterobius Vermicularis infestation of the appendix in a patient who was operated for sigmoid volvulus, which was diagnosed radiologically. Gastrointestinal infection due to Enterobius Vermicularis occurs worldwide and is considered to be the most common helminthic infection.[4]. A clinical picture resembling acute appendicitis may be caused by the worm obstructing the lumen or causing a hypersensitivity reaction in the tissue. However, it is not clear whether the invading organism causes the inflammation or if the parasite is an incidental finding when inflammation is already present.[5]. Usually, the pathogenicity of Enterobius Vermicularis is mild, ranging from asymptomatic to nocturnal anal pruritus. Radiological and laboratory findings are not helpful in pre-operatively distinguishing acute appendicitis related to parasites.[6]. Humans are the only known natural hosts of this parasite. It can have a wide range of pathogenicity, implying that pathologists should be familiar with its histological aspects for accurate diagnosis. The histologic identification of Enterobius Vermicularis or its eggs on resected specimens is not difficult when the pathologist performs a careful search for this parasite. In our case, we could find parasites in the lumen, even macroscopically. Whether they are the causative agents of acute appendicitis or an incidental finding, remains uncertain.[7]. The common histological findings in resected appendiceal specimens range from normal to various inflammatory patterns such as lymphoid hyperplasia, eosinophilic or neutrophilic infiltrate. Enterobius Vermicularis may occasionally be associated with severe inflammation, ulceration and perforation.[6]. The cross-section shows characteristic double and lateral “thorn-like” extensions (alae) from the thin eosinophilic wall of the parasite. Within the wall of parasites, annular structures are easily seen, corresponding to the intestine. Numerous oval eggs, with flattened edges, can be found in gravid females. In solid organs like ovaries, spleen or liver, the histological diagnosis can be tricky as parasites have no sufficient space to develop. Granulomas and other inflammatory changes around oval structures