Posted on 01/18/2010 2:32:12 PM PST by decimon
DALLAS – Jan. 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 appendicitis 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 emergency surgery, hinted that non-perforated appendicitis may resolve without surgery, 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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Other UT Southwestern researchers involved in the Archives of Surgery paper were Dr. Robert W. Haley, chief of epidemiology, and Dr. Adam Alder, a resident and lead author. The team also collaborated with economists at Southern Methodist University on novel statistical methodologies to uncover the associations.
Visit www.utsouthwestern.org/surgery to learn more about UT Southwestern's clinical services in surgery, including gastrointestinal and endocrine procedures.
This news release is available on our World Wide Web home page at www.utsouthwestern.edu/home/news/index
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http://www.utsouthwestern.edu/findfac/professional/0,2356,58399,00.html
Superfluous ping.
Superfluous ping.
Surgical belly ping.
Should the appendix come out. Only if you dont want peritonitis.
Thankfully, they all survived.
So, yes; I have always believed the infection resulting in an inflamed appendix is viral and contagious.
sod, MD
doesn't necessarily = maybe
When dealing with appendicitis maybe is not good enough.
My husband had appendicitis. I took him in on Friday he was asymptomatic so they sent him home. The next day when I took him in they did a CAT scan and found it. They took him into surgery. It burst AS THEY WERE TAKING IT OUT.
hinted that non-perforated appendicitis may resolve without surgery, said Dr. Livingston.
Or not. 16 days in the hospital says that Dr. Livingston can take his "hints" and stuff them where the sun don't shine.
You’re a medical doctor? There seems to be several here.
Are you a Medical Doctor...or from Maryland?
I hope the stuffing leaves him time to determine what microbe, if any, is involved with appendicitis.
Interesting, thanks decimon.
I have been told I have chronic appendicitis. But, since it wasn’t acute the docs in the states won’t help.
I live in the jungle! Literally. So, every twinge in my abdomen causes me to wonder. If this is a viral thing, what can I do?
The doc here in Papua told me, “don’t eat vegetables.”
Back in the 1850s and earlier the general thinking was a person had an infection that ultimately settled in the appendix. When my son neary died from a ruptured appendix back in the 1980s, he started with a horrendous “head cold”.
When I was in school getting a degree as a non-trad, it was absolutely amazing
1-how many things all if a sudden became valid and important-things that any one who raised a famlly knew and 2- some of the absulutely wacky/stupid/idiotic research projects the government funded.
1950s
I am old but not that old.
Our family JUST went through this within the past month. Our 8 year old had an emergency appendectomy before Christmas. Her surgeon, after looking at the pathology report determined that a viral infection (She had H1N1, but treated with Tamiflu, not severe) within the prior 2 months can lead to the internal swelling of the lymph nodes, which put pressure on the appendix, pinching it off, allowing it to become infected over a period of time. Truly, this was the first I had ever heard of an explanation - we were in one of the top hospitals in the country.
The virus being an indirect cause. I don't know what lymph nodes are there but that's an interesting thought.
That I have no problem with.
But saying that appendicitis could just "go away" is reckless.
In all fairness to the doctor he may have been misquoted.
In all fairness to the doctor he may have been misquoted.
I try not to be too critical of these things because someone had to present a complicated matter in just a few paragraphs. Anyone ambitious enough can always search out the original report and deal with the stunning, boggling terminology usually found there.
You're welcome. And remember, it's J., not H.. ;-)
Great, now no one knows wjat tje jell you’re talking about.
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