J Korean Surg Soc.  2009 Apr;76(4):221-224. 10.4174/jkss.2009.76.4.221.

Is the Yersinia enterocolitica Possible Infectious Agent in Acute Appendicitis?

• Son TJ
• Kim DH
• Jo YJ
• Chae JD
• Hong BH
• Kang JH
• Lee TS
• Han JG

• KMID: 1465059
• DOI: http://doi.org/10.4174/jkss.2009.76.4.221

Abstract

PURPOSE: With increasing frequency, Yersinia enterocolitica is being recognized as an important bacterial cause of acute gastrointestinal infection with abdominal pain. In addition, the association of Y. enterocolitica infections with acute appendicitis has been suggested. This study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in acute appendicitis.
METHODS
Between December 2007 and April 2008, 162 patients who underwent appendectomy for presumed appendicitis, enrolled in this prospective study. After surgical excision of appendix, a portion of each specimen was cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin agar).
RESULTS
Pathologically, 150 of the patients had appendicitis and 12 patients had normal appendices. Only one of the 150 patients (0.7%) with appendicitis was found to be culture positive for Y. enterocolitica, while it was not detected from normal appendices.
CONCLUSION
The authors were unable to implicate Y. enterocolitica as a major pathogen in acute appendicitis within the Seoul area. However, we thought there to be more need for investigation for association of Y. enterocolitica with acute appendicitis over a broader area and season.

Keyword

Acute appendicitis; Yersinia enterocolitica

MeSH Terms

Abdominal Pain
Appendectomy
Appendicitis
Appendix
Humans
Prospective Studies
Seasons
Yersinia
Yersinia enterocolitica

Figure

• 

  Fig. 1 Demographic characteristics of the enrolled patients and result of culture for Y. enterocolitica.

• 

  Fig. 2 "Bulls-eye" colonies (dark pink centers surrounded by a translucent border) of Yersinia enterocolitica on cefsulodin-irgasan-novobiocin (CIN) agar after 48 hours.

Reference

1. Kim MS, Hong BH, Kim DH. Management of cecal diverticulitis that's misdiagnosed as acute appendicitis. J Korean Surg Soc. 2007. 73:146–150.

2. Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis: an experimental study. Arch Surg. 1937. 34:496–526.

3. Gray GF Jr, Wackym PA. Surgical pathology of the vermiform appendix. Pathol Annu. 1986. 21(Pt 2):111–144.

4. Cover TL, Aber RC. Yersinia enterocolitica. N Engl J Med. 1989. 321:16–24.

5. Bennion RS, Thompson JE Jr, Gil J, Schmit PJ. The role of Yersinia enterocolitica in appendicitis in the southwestern United States. Am Surg. 1991. 57:766–768.

6. Ahn SH, Suh JT, Chi HS, Lee JD. Five cases of Yersinia enterocolitiea enteritis in adults. Korean J Pathol. 1981. 15:449–457.

7. Lee JH, Rhee PL, Lee JK, Lee KT, Son HJ, Kim JJ, et al. The etiology and clinical characteristics of mesenteric adenitis in Korean adults. J Korean Med Sci. 1997. 12:105–110.

8. Shin HM, Jeong HS, Wang HD, Lee YD, Sung RH. Mesenteric lymphadenitis due to Yersinia enterocolitica: a case report. Korean J Pathol. 2000. 34:1022–1024.

9. Vantrappen G, Geboes K, Ponette E. Yersinia enteritis. Med Clin North Am. 1982. 66:639–653.

10. Saebo A. The Yersinia enterocolitica infection in acute abdominal surgery. A clinical study with a 5-year follow-up period. Ann Surg. 1983. 198:760–765.

11. Attwood SE, Cafferkey MT, Keane FB. Yersinia infections in surgical practice. Br J Surg. 1989. 76:499–504.

12. Winblad S. Erythema nodosum associated with infection with Yersinia enterocolitica. Scand J Infect Dis. 1969. 1:11–16.