Copyright (c) 2025 Saman Taher Barzinjy, Balen Salah Koyee (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
- Articles
- Submited: May 14, 2023
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Published: August 20, 2025
Abstract
Background and objective: Acute appendicitis is the commonest surgical emergencies present throughout all months of the year, but some particular months are associated with higher rates of its incidence. A seasonal pattern of appendicitis with a mostly predominant peak is seen during the summer months in most countries. The aim of this study is to analyze the current knowledge and controversies related to seasonal variability of acute appendicitis in Erbil city.
Methods: A search was conducted using Microsoft Access version 2010, which includes all of the case data from East Erbil Emergency Hospital from March 2, 2010, to November 17, 2021. Some of the patients were eliminated from the study in order to control the incidence of acute appendicitis by season and year.
Results: In this retrospective study, the ages of the patients included were between 1 – 92 years, with a mean age and SD of 24.74 ± 12.29 years, the gender distribution was (56.9%) male and (43.1%) female, in extreme age groups only 316 cases recorded, the most common age group affected by acute appendicitis was teenagers (36.23%), Maximum number of cases presented during summer period (1713 cases, 28.08%) particularly June. while autumn season has least incidence (1293 cases, 21.2%) especially November.
Conclusion: The exact cause of seasonal variation of the incidence of acute appendicitis is still unclear, further studies are necessary to determine the association between seasonal occurrence of acute appendicitis and these factors.
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References
- Nshuti R, Kruger D, Luvhengo T. Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath academic hospital. Int J Emerg Med. 2014; 7:12. doi: 10.1186/1865-1380-7-12.
- Ferris M, Quan S, Kaplan B S. e global incidence of appendicitis. Annals of Surgery. 2017; 266(2):237–41. doi:10.1097/SLA.0000000000002188
- Paajanen H, Gronroos JM, Rautio T, Nordstrom P, Aarnio M, Rantanen T, et al. A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial) BMC Surg. 2013;13:3. doi: 10.1186/1471-2482-13-3.
- Sato Y, Kojimahara N, Kiyohara K, Endo M, Yamaguchi N; Appendicitis study group of Mobi-kids Japan. Association between climatic elements and acute appendicitis in Japan. J Surg Res. 2017; 211:64–9. 10.1016/j.jss.2016.11.064
- Huckins DS, Simon HK, Copeland K, Spiro DM, Gogain J, Wandell M. A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain. Am J Emerg Med. 2013; 31:1368-75. doi: 10.1016/j.ajem.2013.
- Ambulatory and Inpatient Procedures in the United States, 1996 [Internet]. Cdc.gov. 2019 [cited 5 December 2019]. Available from: https://www.cdc. gov/nchs/data/series/sr_13/sr13_139.pdf.
- Karanikolić A, Karanikolić V, Djordjević L, Pešić I. Correlation between the season, temperature and atmospheric pressure with incidence and pathogenesis of acute appendicitis. Srp Arh Celok Lek. 2016; 144(7-8):402–7. PMID: 29652448
- Flum DR, Koepsell T: The clinical and economic correlates of misdiagnosed appendicitis: Nationwide analysis. Arch Surg. 2002; 137:799. doi:10.1001/archsurg.137.7.799
- Williams S, Christopher J K Bulstrode, Ronan P O Connell. The vermiform appendix. Baily &Love Short Practice of Surgery 24th Edition. London, UK. Hodder Arnold 2008:1187.
- Khattak S, Aslam S, Kamal A. Acute Appendicitis: An audit of 663 cases. Gomal J Med Sci. 2010; 8:209-11.
- Kaplan GG, Dixon E, Panaccione R, Fong A, Chen L, Szyszkowicz M, et al. Effect of ambient air pollution on the incidence of appendicitis. CMAJ. 2009; 181:591–7. doi:10.1503/cmaj.082068
- Ahmed W, Akhtar M, Khan S. Seasonal variation of acute appendicitis. Pakistan J Med Sci. 2018; 34(3):564–7. doi: 10.12669/pjms.343.14793
- Lal A, Hales S, French N, Baker MG. Seasonality in human zoonotic enteric diseases: A systematic review. PLoS One. 2012; 7:e31883. doi: 10.1371/journal.pone.0031883.
- Kaplan GG, Dixon E, Panaccione R, Fong A, Chen L, Szyszkowicz M, et al. Effect of ambient air pollution on the incidence of appendicitis. CMAJ. 2009; 181:591-97. doi:10.1503/cmaj.082068.
- Lal A, Hales S, French N, Baker MG. Seasonality in human zoonotic enteric diseases: A systematic review. PLoS One. 2012; 7(4):e31883. doi: 10.1371/journal.pone.0031883
- Rai R, D’Souza RC, V V, Sudarshan SH, P S A, Pai. J R, et al.An Evaluation of the Seasonal Variation in Acute Appendicitis. J Evol Med Dental Sci. 2014; 3:257-60. doi: 10.14260/jemds/2014/1818.
- Lee JH, Park YS, Choi JS. The Epidemiology of Appendicitis and Appendectomy in South Korea: National Registry Data. J Epidemiol. 2010; 20:97-105. doi: 10.2188/jea.JE20090011.
- Bhangu A, Søreide K, Di Saverio S, Assarsson J H, Drake F T, “Acute appendicitis: modern understanding of pathogenesis, diagnosis and management. Lancet. 2015; 386(1000):1278–87. doi: 10.1016/S0140-6736(15)00275-5
- Sulu B, Günerhan Y, Palanci Y, Işler B, Cağlayan K. Epidemiological and demographic features of appendicitis and influences of several environmental factors. Ulus Travma Acil Cerrahi Derg. 2010; 16(1):38–42. PMID: 20209394
- Bahrain Weather Services, “Bahrain climate,” 2020, http://www.bahrainweather.gov.bh/web/guest/climate.
- Ilves I, Fagerström A, Herzig KH, Juvonen P, Miettinen P, Paajanen H. Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland. World J Gastroenterol. 2014; 20:4037-42. doi: 10.3748/wjg.v20.i14.4037.
- Jangra B, Jangra MS, Rattan KN, Kadian YS. Seasonal and day of week variations in acute appendicitis in north Indian children. J Indian Assoc Pediatr Surg. 2013:18:42-43. doi: 10.4103/0971-9261.107021.
- Lin KB, Lai KR, Yang NP, Chan CL, Liu YH, Pan RH, et al. Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study. World J Emerg Surg. 2015; 10:42. doi: 420.1186/s13017-015-0036-3.
- Wei PL, Chen CS, Keller JJ, Lin HC. Monthly variation in acute appendicitis incidence: A 10-year nationwide population-based study. J Surg Res. 2012; 178:670–6. PMID: 22795352 doi: 10.1016/j.jss.2012.06.034
- Gallerani M, Boari B, Anania G, Cavallesco G, Manfredini R. Seasonal variation in onset of acute appendicitis Clin Ter. 2006; 157(2):123-7. PMID: 16817501
- Ferris M, Quan S, Kaplan B S. e global incidence of appendicitis,” Annals of Surgery 2017; 266(2):237–41. doi:10.1097/SLA.0000000000002188
- Bal A, Ozkececi Z T, Turkoglu O, Ozsoy M, Celep R B, Yilmaz S, et al. Demographic characteristics and seasonal variations of acute appendicitis. Ann Ital Chir. 2015; 86:539–44. PMID: 26899348
- Hsu Y J, Fu Y W, Chin T, “Seasonal variations in the occurrence of acute appendicitis and their relationship with the presence of fecaliths in children,” BMC Pediatrics. 2019; 19(1):443. PMID: 31731890 doi: 10.1186/s12887-019-1824-9
- Zhang Y, Lyu F X, Kang Q, Dong Z X, Zhao T X, Xie S N, et al. Association of meteorological factors with pediatric acute appendicitis in China: a 7-year retrospective analysis, Medicine (Baltimore). 2018; 97(42):e12913. doi:10.1097/MD.0000000000012913
- Ilves I, Fagerstrom A, Herzig K H, Juvonen P, Miettinen P, Paajanen H, “Seasonal variations of acute appendicitisand nonspecific abdominal pain in Finland,” World J Gastroenterol. 2014; 20(14):4037–42. doi: 10.3748/wjg.v20.i14.4037
- Sato Y, Kojimahara N, Kiyohara K, Endo M, Yamaguchi N; Appendicitis study group of Mobi-kids Japan. Association between climatic elements and acute appendicitis in Japan. J Surg Res. 2017; 211:64–9. doi: 10.1016/j.jss.2016.11.064
- The global surface temperature keeps rising, despite natural variability,1991-2020. Climate change knowledge patrol. (Accessed September 20, 2023, at https://climateknowledgeportal.worldbank.org/country/nigeria/climate-data-historical#:~:text=The%20central%20regions%20are%20governed,occurring%20over%20March%20to%20October).