Point-of-Care Ultrasound Identification of Motile Enterobius vermicularis in the Appendix of a Toddler: The Youngest Reported Case and Successful Nonoperative Management of Early Appendicitis.

OBJECTIVES: To describe the youngest and second ever reported patient with real-time point-of-care ultrasound (POCUS) visualization of motile Enterobius vermicularis within the appendix and to demonstrate how real-time intraluminal motion aids in distinguishing parasitic infestation from typical obstructive appendicitis.

METHODS: We present the clinical course, ultrasound findings, and management of a 23-month-old girl with acute intermittent abdominal pain.

RESULTS: POCUS revealed a dilated, noncompressible appendix containing multiple linear echogenic structures demonstrating serpiginous, independent motion-highly suggestive of E. vermicularis . Mild periappendiceal echogenicity suggested early acute appendicitis. The patient was successfully managed nonoperatively with albendazole and intravenous antibiotics, experiencing complete symptom resolution within 24 hours. This represents the youngest and second-ever reported patient in whom real-time sonographic visualization of live appendiceal parasites has been reported.

CONCLUSIONS: True intraluminal motility is a critical sonographic discriminator of parasitic infestation and can fundamentally alter management decisions. In this case, early identification of E. vermicularis supported a safe, nonoperative strategy for early appendicitis. Incorporating POCUS early in the evaluation of atypical pediatric abdominal pain may prevent unnecessary surgical intervention.