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A 55-year-old man presented with intermittent, crampy pain in the right lower quadrant of the abdomen. The pain had started two days after his return from a two-week trip to Hungary. He reported no change in bowel movements and no nausea, vomiting, perianal itching, hematochezia, fever, or other systemic symptoms. The physical examination was remarkable only for mild tenderness on deep palpation in the right lower quadrant. The results of routine laboratory testing, including a complete blood count and a metabolic panel with liver-function tests, were normal. A plain radiograph of the abdomen was normal. A colonoscopy was ordered and revealed multiple mobile 1-cm worms, Enterobius vermicularis, in the cecum (Panels A and B and Video Clip). The patient was treated with albendazole, and the abdominal pain resolved. Pain is uncommon but can occur in patients with E. vermicularis infections. The more common symptom of anal pruritus is seen in only 33 percent of patients.
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