Adenoviral Infections: Are They an Underestimated Cause of Acute Appendicitis?

M Metin¹, H Afşarlar², S Şensöz³, N Çoşkun⁴, D Karasartova², ÇE Afşarlar¹

¹Hitit University Faculty of Medicine,Department of Pediatric Surgery
²Hitit University Faculty of Medicine, Department of Clinical Microbiology
³Hitit University, Faculty of Health Science, Nutrition and Dietetics
⁴Hitit University Çorum Training and Research Hospital, Department of Pediatric Surgery

Purpose: Acute appendicitis (AA) is the most common surgical emergency in childhood. Luminal obstruction of the appendix vermiformis by lymphoid hyperplasia due to viral infections is the most proposed cause of appendicitis in childhood. We hypothesized that adenovirus infections may have a significant role in the etiology od AA, and planned a prospective cohort study.

Method: Between October 2024 and May 2025, we prospectively analyzed patients who underwent appendectomy for suspected appendicitis, and accepted to enroll the study. Following appendectomy, 1 cm portion from the tip of the specimens were divided and kept at -80 C⁰ freezer along with stool samples. The remaining portion of the specimens were sent to histopathologic examination. Specimens including appendicoliths or foreign bodies were excluded from the study. Patient demographics, imaging, and laboratory studies were recorded. At the end of the study period tissue and fecal samples were extracted for adenovirus DNA PCR and sequence analysis.

Results: A total of fifty patients with a mean age of 11.9 ± 3.5 were analyzed. Histopathology of the appendectomies were non-complicated AA in 62%, complicated AA in 12% and negative in 26% of the patients. Adenovirus DNA PCR and sequence analysis was positive in two patients with non-complicated appendicitis for Adenovirus serotype 41. None of the patients with complicated appendicitis and negative appendectomies were positive for adenovirus. Stool samples of all patients were negative for adenovirus.

Conclusion: Adenovirus infections have been addressed by limited number of studies with low-sensitive methods in the etiology of AA. This is the first study that adenovirus was analyzed in fresh-tissue samples with simultaneous use of PCR and sequence analysis methods. Although the cohort of this pilot study was limited, adenoviral infections may have a significant role in the etiology of appendicitis. However, our results should be validated with increased number of patients.

Keywords: Acute appendicitis, adenovirus, PCR, sequence analysis, children

M Metin¹, H Afşarlar², S Şensöz³, N Çoşkun⁴, D Karasartova², ÇE Afşarlar¹

¹Hitit Üniversitesi Tıp Fakültesi Çocuk Cerrahisi
²Hitit Üniversitesi, Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı
³Hitit University, Faculty of Health Science, Nutrition and Dietetics
⁴Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi Kliniği

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