# Case Series of Acute Appendicitis Associated With Waterborne Pathogen Exposure in College Students

## TL;DR

This study links acute appendicitis in college students to polluted water consumption in Sudan, showing that water sanitation can reduce cases.

## Contribution

The study provides evidence of a direct link between waterborne pathogens and acute appendicitis in a specific population.

## Key findings

- Pseudomonas aeruginosa was the most common pathogen isolated from patients and water samples.
- Decontaminating the water source led to no new appendicitis cases, suggesting a causal relationship.
- Two patients developed surgical site infections, highlighting the severity of the condition.

## Abstract

This case series investigates the incidence of acute appendicitis among 24 college students in Ad-Damazin, Blue Nile region, Sudan, linked to the consumption of polluted water. This study was conducted from December 21, 2023, to January 4, 2024, with patients presenting to the emergency department exhibiting symptoms consistent with appendicitis. Diagnostic confirmation was achieved through clinical evaluation, radiological imaging, and histopathological examination. Pathogens isolated included Pseudomonas aeruginosa (54.2%), Escherichia coli (20.8%), and Yersinia enterocolitica (8.3%), correlating with pathogens detected in contaminated water samples. Patients with confirmed appendicitis experienced significant morbidity, including surgical site infections in two cases, which extended their hospitalization. Following water source decontamination, no new cases of appendicitis were reported, supporting a direct link between polluted water and appendicitis incidence. This study highlights the role of environmental factors in appendicitis etiology and underscores the necessity for improved water quality management in high-risk areas. Public health interventions targeting water sanitation could significantly reduce appendicitis cases and related complications, emphasizing the need for further research on environmental influences on gastrointestinal health.