Appendicitis may be related to viral infections

January 18, 2010

Can you catch appendicitis? And if you do, is it necessarily an emergency that demands immediate surgery?

Yes and no, according to a new study by UT Southwestern Medical Center surgeons and physicians.

The researchers evaluated data over a 36-year period from the National Hospital Discharge Survey and concluded in a paper appearing in the January issue of Archives of Surgery that may be caused by undetermined viral infection or infections, said Dr. Edward Livingston, chief of GI/endocrine surgery at UT Southwestern and senior author of the report.

The review of hospital discharge data runs counter to traditional thought, suggesting that appendicitis doesn't necessarily lead to a burst appendix if the organ is not removed quickly, Dr. Livingston said.

"Just as the traditional appendix scar across the abdomen is fast becoming history, thanks to new single-incision surgery techniques that hide a tiny scar in the bellybutton, so too may the conventional wisdom that patients with appendicitis need to be operated on as soon as they enter the hospital," said Dr. Livingston. "Patients still need to be seen quickly by a physician, but emergency surgery is now in question."

Appendicitis is the most common reason for emergency general surgery, leading to some 280,000 appendectomies being performed annually.

Appendicitis was first identified in 1886. Since then, doctors have presumed quick removal of the appendix was a necessity to avoid a subsequent bursting, which can be an emergency. Because removing the appendix solves the problems and is generally safe, removal became the standard medical practice in the early 20th century.

But this latest research studying appendicitis trends from 1970 to 2006 suggests immediate removal may not be necessary. Evidence from sailors at sea without access to immediate surgery and from some children's hospitals, whose practice did not call for , hinted that non-perforated appendicitis may resolve without , said Dr. Livingston.

In undertaking the study, the researchers screened the diagnosis codes for admissions for appendicitis, influenza, rotavirus and enteric infections. They found that seasonal variations and clustering of appendicitis cases support the theory that appendicitis may be a viral disease, like the flu, Dr. Livingston said.

Statistical data revealed peaks, which may be outbreaks of appendicitis, in the years 1977, 1981, 1984, 1987, 1994 and 1998. In addition, researchers uncovered some seasonal trends for appendicitis, documenting a slight increase in appendicitis cases during the summer.

"The peaks and valleys of appendicitis cases generally matched up over time, suggesting it is possible that these disorders share common etiologic determinates, pathogenetic mechanisms or environmental factors that similarly affect their incidence," Dr. Livingston said.

Researchers have been able to rule out flu and several other common infections as a direct cause. They also were able to rule out several types of intestinal viruses.

Appendicitis afflicts about one in 10 people during their lifetime. The condition occurs when the appendix becomes obstructed, but doctors are unsure why. Dr. Livingston and other UT Southwestern researchers in 1995 identified an unexpected rise in appendicitis cases, reversing a downward trend throughout the previous 25 years.

"Though appendicitis is fairly common, it still remains a frustrating medical mystery," Dr. Livingston said. "While we know surgical removal is an effective treatment, we still don't know the purpose of the appendix, nor what causes it to become obstructed."

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not rated yet Jan 18, 2010
I have had Appendicitis 3 times over 5 years. I recovered from the first two without anything other than pain, weight loss and extream fatigue. I was contracting at the time and didn't take notice of illness! The third time my appendix burst - real pain and I had to be carried out.

Each occured at a different time of year, place and state of physical fitness. The only common factors were sudden long hours, stress and change in diet - fast food. The surgion noted that those were the factors he found brought people to his table. He thought it was probably an overloaded immune system through some sudden change in environment!
1 / 5 (2) Jan 18, 2010
As a child I was told that my abdominal pain was caused by a - cholic appendix. The doctor advised not to eat food containing small seeds, passionfruit for example. I have not eaten passionfruit since. Recently in intense abdominal pain, my appendix was removed and I explained to the surgeon my childhood experience and he replied he had never heard the term cholic appendix and insisted that appendicitis was always due to intestinal irritation from spices, especially pepper. Now, it might be a contagious virus. I would expect that post surgery tests on the appendix would easily confirm a viral infection. We have statistics to examine, we are very busy and cant do real science.
1 / 5 (1) Jan 18, 2010
If they missed an outbreak in 1990 that would show a recurring pattern of about 41 months between outbreaks, probably not significant, just something I noticed.
1 / 5 (1) Jan 18, 2010
bluehigh: Keep in mind that surgeons are not picked for their intelligence, but rather for their steady hands and nerves of steel (and that's not a bad thing, since those are the two qualities that they need most).

Relying on a non-specialist surgeon for general medical information is pretty much as useful as getting your news from Fox or the National Enquirer. Go to a real doctor if you want to know what's going on.

Also, keep in mind that as doctors age, so does their medical knowledge. Some keep up with the state of the art, and some don't. Younger means more inexperienced, but it also means that they're more likely to be versed in, you know, not using leeches for everything:P.

I'll also note that appendicitis is a symptom, rather than an illness in and of itself. It likely has more than one cause, with one of the causes being by far and away more common than the others.
not rated yet Jan 19, 2010
If appendicitis were the result of a virus, like the flu, then why would it not infect many people at once?

I had my appendix removed in 1984. The day I noticed symptoms it was warm and sunny. On a bet, I had eaten a peanut butter and banana sandwich. I suspected it might have been something bad in the banana. On the other hand, nobody else got sick, so I suppose that wasn't the problem.

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