Jack Nowell's build-up to the World Cup has suffered another setback after he was forced to have his appendix removed at England's training camp in Treviso.

The Exeter wing spent four nights in hospital after first experiencing pain upon arrival in north east Italy last Wednesday.

An operation was completed that same night and he was released on Sunday to continue his recovery.

Nowell has yet to make an appearance in the three World Cup warm-up games staged so far this summer as he recovers from the ankle injury sustained in the Gallagher Premiership final.

He will not be involved in Friday's send-off against Italy at St James' Park either, leaving the tournament opener against Tonga on September 22 in Sapporo as his likely comeback match.

"Jack was sick. He had appendicitis and came out of hospital yesterday. He's nice and hungry! He's in good spirits and is back running," defence coach John Mitchell said.

"It's a sickness that you can't deal with too much and you lose a bit of weight, but we back Jack. It's about being supportive and making sure he gets healthy.

"His general ankle progression is in line with where he needs to be. He's right on target for us. I don't know how much weight he's lost but he looks lean."

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.

Tuesday is England's main practice session ahead of the visit of the Azzurri on Friday and Slade will need to prove his fitness if he is to have any chance of being involved.

Mako Vunipola's rehabilitation from a hamstring problem is progressing on schedule, leaving him with another five to six days of recovery time.