Abstract / Summary
Background/Objectives: Acute appendicitis is readily recognised, but its initiating mechanisms remain uncertain. Viral findings are often interpreted without separating direct appendiceal infection, systemic host responses, clinical phenocopies, and virome effects. We examined the evidence for these scenarios and their possible relationship to spontaneous resolution. Methods: A structured narrative synthesis of 82 publications integrated tissue studies, clinical series, epidemiology, microbiome and virome research, natural history, and treatment outcomes. Results: Direct viral injury is documented in rare clinicopathological settings. Available tissue studies argue against frequent direct adenoviral infection. Systemic infection could provoke lymphoid activation, oedema, or early microvascular injury, but this causal sequence has not been demonstrated in humans. Clinical studies document resolution in selected uncomplicated cases, including recovery without antibiotics, without establishing a viral cause. Conclusions: The framework separates observed findings from competing causal hypotheses. A viral prodrome is a candidate research variable whose independent diagnostic and prognostic value remains unestablished. Prospective studies must link infection chronology to local inflammation and subsequent outcomes before such information can guide treatment. Viral symptoms or positive tests cannot justify withholding indicated antibiotics or surgery.