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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.

The virus being an indirect cause. I don't know what lymph nodes are there but that's an interesting thought.

Acute appendicitis, more often than not, is initiated by a fecolith obstructing the lumen of the appendix. The distal portion of the appendix is full of stool and with stasis allows the content to further putrify, leading to infection of the appendix. As the appendix becomes increasingly inflamed, it swells distending the wall of the appendix...stretching it, as it were, like the wall of a balloon,...stretching it so tight that the appendiceal artery becomes occluded, thus depriving the appendix of vital blood supply. This leads to a necrotic wall, and soon after, rupture.

It is possible that an appendix without a fecolith could become inflamed by an infectuous agent, causing the lymphoid follicles in the wall of the appendix to swell, resulting in the stasis of feculent matter in the appendix an setting off the same series of events as mentioned above.

In my residency (general surgery) we were taught there was no clinical entity known as chronic appendicitis, however, if a person came in repeatedly with right lower quadrant pain, without the concurring lab fidings (elevated WBC with a left shift) after 3 everts we performed an appendectomy. Most times this resolved the problems.

In third world countries, there is an entity known as tifilitis. It is, in effect, an infestation of round worms (ascaris or vermicularis) in the caecum which results in obstruction of the appediceal lumen, evolving onward to appendicitis.

I have removed several thousand appendix in my practice, but other than appendiceal carcinoma, I don't know a damn thing about the appendix.

The lymph system is a system of one way valves that collects the excess water in the body and dumps it back into circulation (water is pushed out of the capillaries due to high pressure).

It is also one of the main thoroughfares for the immune system.

Swollen lymph nodes is often a sign of infection.