Bowel Infection and Acute Appendicitis

This paper seeks to correct the widely held belief that a clinical or bacteriological diagnosis of infec- tive diarrhoea excludes the presence or development of acute appendicitis.The work that is described was stimulated by isolated incidents that occurred between 1950-1955: these are summarized in Table 1.In that period nine children had appendicectomies either when a bowel infection was present or before such an infection became manifest in the post-operative period: at operation four out of these nine cases were found to have acute appendicitis.A pre- liminary communication on the thesis of this paper was read at this hospital at a Summer meeting of the Paediatric Section of the Royal Society of Medicine in 1957 (Rogers, 1957).Because of the findings shown in Table 1 an investigation was organized to inquire into the role of bowel infection as a factor in the aetiology of acute appendicitis: it was quite fortuitous that our planned project was started in January 1956, when a pandemic of Sonne dysentery in England was beginning.Investigations Main Investigation, 1956.In 1956 at the Children's Hospital Birmingham, there were 250 appendicec- tomies.The patients concerned represent 4-4% of a total of 5,730 patients admitted that year.Of these, 160 were suffering from acute appendicitis and all the appendices from them were examined, the distal two-thirds of each being sent for histological examination and the proximal one-third being used for bacteriological examination.When peritonitis was present, peritoneal pus or fluid was investigated.Examination and culture of the faeces were also performed.If no faeces was available a sheathed rectal swab was employed to obtain a true rectal specimen (Rogers, 1954).Twelve of the 160 patients were found to have Shigelia sonnei in their appendices and it was thought that most of these patients had dysentery due to that organism as well as acute inflammation of the appendix.Table 2 presents the main symp- toms, findings at operation and bacteriological investigations of each of these 12 cases.There was, in addition, a girl (Case 13, Table 2) who developed acute appendicitis with abscess formation while she was suffering from a salmonella infection.The normal appendices removed from 20 patients, were also cultured by the same techniques and neither Sh. sonnei nor salmonellae were isolated.Eleven of the 12 strains of Sh. sonnei were identified on the primary cultures and one was only isolated by selenite enrichment.* All had acute appendicitis.