England will not be deterred from taking Jack Nowell to the World Cup despite the latest setback that forced the Exeter wing to undergo emergency surgery in Treviso.
Nowell's miserable run of luck continued on arrival at the squad's training camp in north-east Italy last Wednesday, when stomach pain saw him admitted to a local hospital.
That same evening his appendix was removed and it was not until four nights later that he was released to continue his recovery, several kilograms lighter and with a ferocious appetite.
It was the latest twist in a tale of woe that has prevented him from taking part in the three World Cup warm-up games staged so far this summer.
An ankle injury sustained during the Gallagher Premiership final on June 2 resulted in surgery and, following a complication during his rehabilitation, Exeter boss Rob Baxter declared he is "touch and go" to be ready for Japan.
But England have indicated he will travel to the Far East regardless of the appendix issue in the expectation that, by the time the critical Pool C games against Argentina and France are staged, he will be healthy and at full fitness.
As his blockbusting performance in the Premiership final indicated, Nowell is a versatile back-three player who repeatedly breaks tackles. If fit, he is a certainty for Eddie Jones' matchday 23.
"Jack's been 'gutsing' it a bit. He's a resilient bugger, a good character and not a lot gets him down. But he's nice and hungry!" defence coach John Mitchell said.
"He's in our World Cup squad. We'll be backing Jack. We're no different to a lot of squads. Everyone's got niggles and bits and pieces. You've got to back and support that risk.
"There's always risk. We've got to back our own instincts, our own intuition and our own strategies rather than falling into the trap of being hasty.
"At this point in time we back Jack and we'll support him to get to that point. We wouldn't be doing what we're doing unless we thought that's the way that he's heading."
Speaking at England's World Cup squad announcement last month, Nowell revealed the injuries that have plagued his Test career have taken an emotional toll.
"Over the last couple of years if I'm honest I've really, really struggled with my injuries," Nowell said.
"Normally I'm pretty positive and can find something to work on, but I have really struggled.
"You feel a little that you are letting them down that you can't be out there all the time.
"You play because you want to play every single game so to be told, or for your body to tell you that you can't play is the most frustrating thing.
"When I tore my hamstring in training in the autumn international I didn't actually believe it.
"The physios were telling me and the scans were telling me but it was actually killing me to be told I would be out for six or seven weeks. I was in denial."
Nowell's Exeter team-mate Henry Slade appears increasingly unlikely to play against Italy as he he continues his recovery from a knee injury.
Slade has also missed the double header against Wales and rout of Ireland to confront him with the prospect of entering the World Cup without a minute of game time in the bank since the Premiership final on June 1.
Wing Ruaridh McConnochie is expected to make his debut against Italy after recovering from a hamstring injury.