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Study Questions Need for Emergency Appendectomies

MONDAY Jan. 18, 2010 -- Appendicitis doesn't necessarily lead to a burst appendix if the organ isn't removed quickly, U.S. researchers say in a new study that challenges traditional belief.

The researchers also theorize that viral infections can cause appendicitis.

"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," the study's senior author, Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center in Dallas, said in a news release from the hospital.

"Patients still need to be seen quickly by a physician, but emergency surgery is now in question," he said.

Livingston and his colleagues analyzed 36 years of data from the National Hospital Discharge Survey and identified seasonal variations and clustering of appendicitis cases that, he said, support the theory that appendicitis may be a viral disease, like the flu.

It's not clear what types of viruses may cause appendicitis, although the researchers said they were able to rule out various intestinal viruses and also ruled out flu and several other common infections as a direct cause.

Their analysis of appendicitis trends from 1970 to 2006 also indicated that immediate removal of the organ might not be necessary in all people, they said. Cases involving sailors at sea without access to immediate surgery and patients at children's hospitals where emergency surgery was not standard practice suggest, according to the researchers, that non-perforated appendicitis can resolve without surgery.

The study is in the January issue of Archives of Surgery.

Appendicitis, which affects about 10 percent of the population, is the most common reason for general emergency medical surgery, according to background information in the news release. About 280,000 appendectomies are performed each year in the United States.

"Though appendicitis is fairly common, it still remains a frustrating medical mystery," 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."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about appendicitis.

Posted: January 2010


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