A serendipitous inhabitant in the ileum detected during bowel surgery in a case of high-grade urothelial carcinoma

Debasish Biswal1, Nishant Verma1, Bijay Ranjan Mirdha1

Patient description

Many tapeworms were seen in the ileum of a 58-years old male patient diagnosed with high grade urothelial carcinoma during the procedure of radical cystectomy and ileal conduit formation. Many of these were removed and a part of the worm about the size of two metres was examined.

Parasitological follow up

The worm was segmented, consisting of fifty-four proglottids, with swollen terminal six proglottids, possibly gravid segments. The gravid segment measured around 20 mm × 16 mm in length and breadth, respectively (Figure 1). One of the gravid proglottid was gently pressed between two slides to obtain eggs. Eggs were round, bile-stained, measuring 36 μ in size, with characteristic oncosphere with six hooklets surrounded by embryophore (Figure 2). Upon modified Ziehl-Neelsen staining, eggs appeared pink in colour showing relative acid-fastness (Figure 3). Gravid proglottid was processed for fixation, preservation for subsequent staining and mounting using standard method to visualise central uterine stem and lateral branches. Number of uterine lateral branches in examined proglottid were 19 in number on each side (Figure 4). Examination of three consecutive stool samples on three consecutive days did not reveal any parasitic infestations besides serum sample being negative for Taenia solium IgG antibodies. From the above observations, the segment was considered a part of the adult Taenia saginata, as Taenia solium uterine lateral branches are 7-13 in number [1].


Although taeniasis is not a common intestinal infection compared to intestinal nematode and protozoa infections in India, the algorithm for the diagnosis of taeniasis is same as processing of stool samples. Besides asking for passage of proglottids (worms) in suspected patients, these are wet-mount examination prepared both directly and using concentration techniques of three stool samples on three consecutive days to demonstrate characteristic eggs. Taenia solium specific IgG antibodies are also detected by ELISA. Both these tests are being done in our laboratory.

Compared to taeniasis, neurocysticercosis (NCC) is reported more commonly in India and investigated using standard recommended procedures using both imaging techniques and serological assays.

The patient was treated with praziquantel with resolution of infection. Pre-operative evaluation of intestinal parasitosis in patients undergoing bowel surgery warrants investigations of intestinal parasitosis.


[1] Garcia LS. Intestinal Cestodes. (in) Diagnostic Medical Parasitology. ASM Press, Washington 2016, pp. 420-1. http://dx.doi.org/10.1128/9781555819002

Conflict of interest: none declared.

Authors’ affiliations:
1 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.

Corresponding author:
Bijay Ranjan Mirdha
Professor, Department of Microbiology
All India Institute of Medical Sciences
New Delhi
e-mail: mirdhabr@hotmail.com

To cite this article: Biswal D, Verma N, Mirdha BR. A serendipitous inhabitant in the ileum detected during bowel surgery in a case of high-grade urothelial carcinoma. World J Med Images Videos Cases 2022; 8:e80-4.

Submitted for publication: 15 August 2022
Accepted for publication: 2 October 2022
Published on: 25 November 2022

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Figure 1. Part of the tapeworm (gross): segmented, 54 proglottids, swollen terminal 6 proglottids (possibly gravid), each proglottid measuring 20 mm × 16 mm length and breadth, respectively.
[please click on the image to enlarge]

Figure 2. Taenia eggs on wet mount microscopy (400× magnification): round, bile-stained eggs, measuring 36 μ in size, with characteristic oncosphere with six hooklets surrounded by embryophore.
[please click on the image to enlarge]

Figure 3. Taenia egg on modified Ziehl-Neelsen stain (1000× magnification): pink coloured egg showing relative acid-fastness.
[please click on the image to enlarge]

Figure 4. Uterine stem with lateral branches: central uterine stem with its lateral branches filled with Taenia eggs.
[please click on the image to enlarge]

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