Enterobius vermicularis, commonly known as the pinworm, is a prevalent intestinal nematode, particularly affecting children worldwide. Although infection is often asymptomatic, it may occasionally lead to complications, including appendiceal involvement. The role of E. vermicularis in the pathogenesis of acute appendicitis remains controversial and is frequently overlooked. We report a case of a 10-year-old child who presented with intermittent right lower quadrant abdominal pain without fever or systemic symptoms. Initial ultrasound revealed small mesenteric lymph nodes, with no clear evidence of appendiceal pathology. Empirical treatment with antibiotics and anti-inflammatory agents failed to relieve the symptoms. A follow-up ultrasound demonstrated a thickened retrocecal appendix with hypoechoic intraluminal content. Due to persistent pain, a laparoscopic appendectomy was performed, revealing a white, non-segmented roundworm within the appendiceal lumen. Histopathological examination and direct microscopic analysis confirmed follicular appendicitis with intraluminal nematodes morphologically consistent with E. vermicularis. Postoperative parasitological examination further supported the diagnosis, with detection of characteristic eggs using the Scotch tape test, while stool examinations remained negative. These findings suggested E. vermicularis as the most likely etiological agent and supported its pathogenic role in the patient's clinical presentation. The patient was treated with albendazole, followed by a second dose 2 weeks later. Simultaneous treatment was administered to household contacts, and strict hygiene measures were recommended to prevent reinfection. Clinical recovery was complete, with no postoperative complications. This case highlights the importance of considering parasitic infections in the differential diagnosis of acute abdominal pain, even in the absence of systemic inflammatory markers, particularly in endemic or underrecognized settings. Early recognition and targeted therapy are essential to prevent recurrence and intra-familial transmission.

Epiploic appendagitis (EA) is a rare, benign, and usually self-limiting cause of acute abdominal pain resulting from inflammation or torsion of an epiploic appendage. It is typically managed conservatively with analgesia and non-steroidal anti-inflammatory medication. We report a case of a 22-year-old male who presented with acute right lower quadrant pain and radiological findings consistent with EA. Despite initial conservative management, he represented with worsening pain and rising inflammatory markers. Repeat imaging demonstrated progression of inflammatory change, atypical for uncomplicated EA. Diagnostic laparoscopy revealed a necrotic epiploic appendage walled off by adherent greater omentum, which was excised. The patient experienced near-immediate symptom resolution and was discharged on post-operative day 1, remaining well at follow-up. Although EA is generally self-limiting, clinical deterioration or atypical radiological development should prompt reassessment. In selected cases, laparoscopy can be both diagnostic and therapeutic.

Meckel's diverticulum is a congenital anomaly of the gastrointestinal tract that occurs in approximately 2% of the population. It is the result of incomplete obliteration of the vitelline duct (ductus omphaloentericus). During the fetal period, this duct connects the yolk sac with the primitive intestine and normally closes around the 5th-7th week of gestation. It is a true diverticulum because it contains all layers of the intestinal wall. Most diverticula are asymptomatic; however, they may lead to serious complications such as inflammation, perforation, obstruction, and bleeding. Our case report presents a case study of an 18-year-old patient who presented to the surgical outpatient clinic with several hours of abdominal pain in the right lower quadrant, mimicking acute appendicitis. However, the perioperative findings confirmed a different pathology: a perforation of Meckel's diverticulum.

This case describes a 31-year-old male who presented with acute exacerbation of pre-existing, undiagnosed Crohn's disease (CD) one week after rapid ascent to 4,500 meters. The patient had a long-standing history of recurrent oral ulcers and perianal fistulas. He was initially misdiagnosed with acute appendicitis based on right lower quadrant pain and fever, which resulted in emergency surgery. On postoperative day 9, life-threatening gastrointestinal bleeding (GIB) occurred. Management at the remote high-altitude facility was challenged by diagnostic limitations (lack of advanced imaging and endoscopic equipment), blood supply shortages, and lack of advanced interventions, which hindered the timely identification of the underlying disease and bleeding site. After emergency evacuation to lower altitude, GIB resolved spontaneously. Colonoscopy revealed ileocecal valve ulcers. Two-year follow-up with recurrent GIB and progressive intestinal ulceration further confirmed the diagnosis of CD. This case highlights ultra-high altitude exposure as a potential trigger for acute exacerbation of pre-existing CD, where atypical presentation often leads to misdiagnosis. The importance of recognizing extraintestinal manifestations in acute abdominal conditions is emphasized, alongside the critical challenges in managing complex cases in resource-limited high-altitude settings.

Tuberculous appendicitis is a rare form of extra-pulmonary tuberculosis that commonly mimics acute appendicitis and is usually diagnosed only after histopathological examination. A 35-year-old man presented with a 1-year history of intermittent abdominal pain and mucoid diarrhea before developing acute right lower quadrant pain due to perforated appendicitis requiring emergency appendectomy. Histopathology revealed caseating granulomatous inflammation consistent with tuberculous appendicitis. The patient completed 6 months of standard anti-tubercular therapy with complete resolution of symptoms. Due to its nonspecific clinical and radiologic presentation, tuberculous appendicitis is rarely diagnosed preoperatively. Routine histopathological examination of appendectomy specimens remains essential for diagnosis. Combined surgical and medical management typically results in an excellent prognosis.

Appendiceal diverticulosis is a rare condition, with a reported incidence ranging from approximately 0.004% to 2.1%, and it may remain clinically silent or present with inflammation that closely resembles acute appendicitis. Distinguishing appendiceal diverticulitis from typical appendicitis preoperatively is often challenging because clinical manifestations and imaging findings are frequently nonspecific and may suggest an appendiceal phlegmon or localized perforation rather than a separate diverticular pathology. Definitive diagnosis is usually established by histopathological examination following appendectomy, which is also essential for assessing perforation and for excluding associated neoplastic changes. We report the case of a 34-year-old female who presented with right lower quadrant abdominal pain, nausea, and clinical findings consistent with acute appendicitis. Radiological evaluation suggested appendiceal inflammation with associated phlegmon formation. The patient underwent surgical intervention, and intraoperative findings revealed a ruptured appendiceal diverticulum with adjacent inflammatory changes. Histopathological examination confirmed perforated appendiceal diverticulitis with no evidence of malignancy. The postoperative course was uneventful, and the patient recovered well. This report highlights the importance of considering appendiceal diverticulitis in the differential diagnosis of acute right lower quadrant pain and emphasizes the role of careful histopathological evaluation after appendectomy to ensure accurate diagnosis and appropriate management.

Acute appendicitis is a common surgical emergency. However, its atypical presentations, such as mechanical small bowel obstruction (SBO), are exceedingly rare and diagnostically challenging. This is particularly true in patients with prior abdominal surgery, where postoperative adhesion is the most clinically significant cause. We report a 31-year-old man with a history of previous open gastro-jejunostomy who presented with progressive abdominal pain, distension, vomiting, and obstipation. Initial suspicion favored adhesive SBO; however, contrast-enhanced CT revealed a distended, inflamed appendix with marked peri-appendiceal inflammation causing distal ileal obstruction, distinct from the previous surgical site. Urgent exploratory laparotomy confirmed dense adhesions tethering the ileum to the inflamed appendix, which was successfully managed with adhesiolysis, release of the entrapped ileal segment, and appendectomy. The patient recovered uneventfully. This case underscores that prior abdominal surgery should not preclude consideration of appendicitis as a possible primary cause of mechanical SBO, particularly in patients with clinical features suggestive of an inflammatory process localized to the right lower quadrant. Additionally, it highlights the pivotal role of CT in differentiating inflammatory from adhesive obstruction and emphasizes the need for prompt surgical intervention to achieve favorable outcomes.