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Invited Commentary
March 4, 2020

Acute Appendicitis Incidence—Predisposing Factors, From Microbiota to Socioeconomic Status?

Author Affiliations
  • 1Department of Surgery, University of Turku, Turku, Finland
  • 2Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
  • 3Satakunta Central Hospital, Pori, Finland
JAMA Surg. Published online March 4, 2020. doi:10.1001/jamasurg.2019.6031

Acute appendicitis is actually 2 different diseases; uncomplicated and complicated appendicitis differ both epidemiologically and clinically, indicating different pathophysiology. The previous line of thinking that appendicitis invariably progresses to perforation has resulted in the surgical dogma for emergency appendectomy for all patients. This has been refuted by the fact that most cases are of an uncomplicated nature, which may be successfully treated with antibiotics1 or perhaps even symptomatic therapy,2,3 avoiding unnecessary surgery and the associated morbidity and increased treatment costs.4 Despite high incidence of appendicitis, there are very few studies on causative mechanisms and pathophysiology, especially ones focusing on the possible differences between uncomplicated and complicated appendicitis.

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