Chronic appendicitis: Symptoms, treatment, and outlook

Chronic appendicitis is long-lasting inflammation of the appendix. Though rare, it can become extremely painful and, in some cases, life-threatening.

In this article, we look at the symptoms and diagnosis of chronic appendicitis, as well as how the condition is treated.

Share on PinterestThe appendix is connected to the bottom of the large intestine.

The appendix is a small pouch shaped like a finger or sausage. It is connected to the bottom of the large intestine. Appendicitis occurs when the appendix becomes inflamed and infected. The first noticeable symptom of appendicitis is usually abdominal pain.

People with chronic appendicitis have appendicitis that lasts for long periods of time. This means appendicitis that is present for longer than a week.

Chronic appendicitis is relatively rare, with just an estimated 1.5 percent of all appendicitis cases being considered chronic appendicitis.

Chronic appendicitis may occur for many different reasons and many cases do not have a clear cause.

Often, chronic appendicitis occurs due to inflammation and obstruction of the appendix. Other possible causes include:

• accumulation of fecal matter, which can happen if someone is constipated
• calcified fecal deposits, also known as ‘appendix stones’
• trauma to the abdomen
• tumors
• enlarged lymph nodes and glands
• worms
• a buildup of foreign objects, such as stones, marbles, or pins

Share on PinterestMild abdominal pain may be the first symptom of chronic appendicitis.

Chronic appendicitis can be difficult to diagnose, as symptoms may be fairly mild and easily mistaken for a different condition.

Many people experience mild abdominal pain at first, and this may remain as their only symptom.

The pain is usually located on the lower right side of the abdomen but can spread towards the belly button. The pain can either be dull or sharp.

As well as abdominal pain, people with chronic appendicitis may also experience the following symptoms:

• fever
• swelling and tenderness of the abdomen
• feeling tired and having no energy
• nausea or diarrhea
• malaise or a general feeling of being unwell

Not all people with chronic appendicitis will have all of these symptoms. Symptoms may also subside on their own and then return, making it more challenging for doctors to give an accurate diagnosis if a person is not experiencing the symptoms at the time.

However, because chronic appendicitis can become life-threatening, it is important that people with recurrent abdominal pain and the above symptoms seek medical attention, particularly if the symptoms become more severe.

While chronic and acute appendicitis have similar symptoms, there are important differences between them.

Chronic appendicitis is where a person has symptoms that last for a long time, and these symptoms usually come and go. If chronic appendicitis is not diagnosed, the person can continue to experience symptoms for years.

Acute appendicitis is when a person suddenly develops severe symptoms, typically over the course of 24–48 hours. These symptoms will be impossible to ignore and require immediate emergency medical treatment.

The most typical symptom of acute appendicitis is abdominal pain that starts around the belly button and moves to the lower right side of the tummy. This pain may start out as mild and dull, but is likely to intensify.

Other symptoms of acute appendicitis include:

• nausea with or without vomiting
• low-grade fever
• constipation or diarrhea
• lack of appetite
• inability to pass gas

Appendicitis usually occurs when an obstruction, such as a foreign object or calcified stool, blocks the inner cavity or appendiceal lumen of the appendix.

Chronic appendicitis may occur when the appendiceal lumen is only partially blocked. However, the blockage is likely to worsen over time by causing pressure to build.

When this happens in people with chronic appendicitis, the pressure may overcome the partial obstruction and the symptoms will reduce in intensity or go away altogether.

The symptoms will then return the next time the blockage causes the appendix to become inflamed.

Share on PinterestAn appendectomy is the most common treatment for chronic appendicitis.

A doctor will initially do a physical exam to determine whether the abdomen is tender and where the pain is located. They will also ask questions about the symptoms and a person’s medical history.

In most cases, a doctor will do several tests to rule out other medical conditions that have the same symptoms.

The conditions the doctor may attempt to rule out include:

• urinary tract infection
• kidney infection
• Crohn’s disease
• ulcerative colitis
• ovarian cysts
• pelvic inflammatory disease (PID)
• irritable bowel syndrome (IBS)
• other gastrointestinal disorders

The tests used to rule out these conditions include:

• blood tests
• a pelvic exam
• a pregnancy test
• urinalysis or testing a person’s urine
• computerised tomography (CT) scan
• abdominal ultrasound
• magnetic resonance imaging (MRI)

If chronic appendicitis is diagnosed, the doctor may prescribe antibiotics or may advise draining the pus that has formed around the appendix due to the infection.

The most common treatment, however, is to have the appendix removed altogether. This surgery is called an appendectomy.

An appendectomy is usually performed using laparoscopic surgery, which is minimally invasive. It is also known as keyhole surgery and is performed under general anesthetic.

The most common complications of chronic appendicitis are:

• acute appendicitis
• a ruptured appendix or when a person’s appendix bursts
• an abscess or when a pocket of pus develops around the appendix
• sepsis or when chemicals are released into the bloodstream, causing the whole body to become inflamed
• peritonitis or inflammation of the abdomen’s lining

The above complications are serious and require immediate medical care. It is vital not to ignore symptoms of appendicitis, and to seek medical attention urgently.

Outlook

Chronic appendicitis is a long-term condition characterized by appendicitis symptoms that come and go over time. It is different from acute appendicitis, but it can also have serious complications.

While a person may live with chronic appendicitis for years, it is important that they do not ignore the symptoms. Recurring pain in the lower abdomen can be a symptom of many underlying conditions, so it is vital to get a proper diagnosis.

Definition, causes, treatment, and more

Acute appendicitis is the sudden and severe inflammation of the appendix. It can cause pain in the abdomen, and this pain may occur quickly and worsen within hours.

The appendix is a narrow tube that attaches to the large intestine. It is located in the lower righthand side of the abdomen.

Any blockage or inflammation affecting the appendix can lead to swelling, causing acute appendicitis.

This article will look at the causes, symptoms, treatment options, and recovery details associated with acute appendicitis.

Acute appendicitis is a medical emergency. People will need immediate medical care if they have any symptoms of appendicitis.

Without treatment, the appendix can rupture or burst within 48–72 hours of a person first experiencing symptoms of acute appendicitis. A ruptured or burst appendix can lead to a serious infection called peritonitis, which can be life threatening without prompt treatment.

The symptoms of acute appendicitis occur suddenly and are usually severe. They may worsen over the course of a few hours.

It is best to avoid taking any pain relief medication for symptoms of acute appendicitis, as this could mask symptoms that a doctor will need to know about.

In adults

Symptoms of acute appendicitis in adults can include:

• pain around the belly button, which may move to the lower righthand side of the abdomen
• a swollen abdomen
• vomiting
• loss of appetite
• fever and chills
• constipation or diarrhea
• difficulty passing gas

The pain may worsen over time or with movement, deep breaths, coughing, sneezing, or touching the abdomen.

If the appendix bursts, a person may feel pain across the whole of the abdomen.

In children

Children may experience the following symptoms of acute appendicitis:

• general discomfort or malaise
• loss of appetite
• abdominal pain, which may move to the lower righthand side of the abdomen
• nausea and vomiting
• low grade fever
• an increased heart rate

Acute appendicitis occurs when something blocks the inside of the appendix. This could be due to:

• a viral, bacterial, or parasitic infection in the digestive tract, which can enlarge the tissue of the appendix wall
• stools causing a blockage in the tube between the large intestine and the appendix
• tumors
• inflammatory bowel disease
• injury or trauma to the abdomen

This results in the appendix becoming swollen and inflamed.

According to Johns Hopkins, as the swelling increases, the blood supply to the appendix reduces and stops. Without enough blood, the appendix may start to die, or it could tear or burst.

For acute appendicitis, people will need immediate surgery to remove the appendix. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that receiving immediate treatment reduces the risk of the appendix bursting.

There are two types of surgery to remove the appendix: laparoscopic surgery and laparotomy surgery.

In laparoscopic surgery, a surgeon will make several small cuts in the abdomen to remove the appendix. In laparotomy surgery, they will make a single cut in the lower righthand side of the abdomen to remove the appendix.

If the appendix has burst, it could cause a serious infection within the lining of the abdominal wall. The surgeon will remove the appendix with surgery and clean the inner abdomen to prevent any infections.

Is surgery necessary?

In some cases, antibiotics may be enough to cure mild cases of acute appendicitis. A doctor will prescribe antibiotics to anyone who may have appendicitis.

According to the NIDDK, laparoscopic surgery has a lower risk of complications and a quicker recovery time than laparotomy surgery.

People will need to limit their physical activity for 3–5 days after laparoscopic surgery or for 10–14 days after laparotomy surgery.

To diagnose acute appendicitis, a doctor will take a medical history and carry out a physical examination. They may also perform the following:

• a blood test to check for a high white blood cell count, which can signal infection
• a urine test to check for urinary tract infections
• an abdominal ultrasound to check how the internal organs are working and to monitor blood flow
• a CT scan to produce a detailed image of the inside of the body
• an MRI scan, which a doctor may use instead of a CT scan if the person is pregnant

Without prompt treatment, acute appendicitis can cause the appendix to burst. This can lead to a condition called peritonitis.

Symptoms of peritonitis include:

• nausea
• fever
• vomiting
• severe tenderness in the abdomen

Peritonitis is a serious infection that can be life threatening without immediate treatment. To treat peritonitis, a surgeon will remove the appendix and clean the inside of the abdomen.

The NIDDK notes that untreated acute appendicitis can also lead to an appendiceal abscess. If this occurs, the surgeon will drain the abscess before or during surgery.

To do this, they will place a drainage tube into the abscess, and the person will need to leave this tube in for 2 weeks while taking antibiotics. After 6–8 weeks, the surgeon will remove the rest of the appendix.

Receiving immediate surgery can treat acute appendicitis. Most people make a full recovery after surgery for appendicitis.

People will not need to make any changes to their diet or lifestyle after surgery, and most people are able to live healthy lives without their appendix.

According to one 2015 case report, chronic appendicitis is a rare and less severe type of appendicitis.

With chronic appendicitis, a person may experience continuous abdominal pain that may last for weeks, months, or years. This pain can range from mild to moderate. A fever may also be present.

Researchers do not know the exact cause of chronic appendicitis. However, it may result from a partial and consistent blockage in the appendix.

Chronic appendicitis is not a medical emergency. However, without a diagnosis, chronic appendicitis could lead to serious complications.

Learn more about chronic appendicitis here.

Acute appendicitis refers to the sudden and severe inflammation of the appendix. Acute appendicitis is a medical emergency, and people will need medical care straight away.

People will usually need to undergo surgery to remove the appendix. Receiving prompt treatment can help prevent the appendix from bursting. A burst appendix is a serious complication. It can cause a dangerous infection and will need immediate treatment.

Most people will make a full recovery from appendicitis and can live normal, healthy lives without their appendix.

Acute appendicitis | MyPathologyReport.ca

Madeleine Fitzpatrick, MD, and Stephanie Reed, MD, FRCPC
March 6, 2023

What is acute appendicitis?

Acute appendicitis is a non-cancerous disease caused by: acute inflammation in the appendix a small finger-shaped organ that connects to the large intestine (colon) through a small opening. For most people, the appendix is ​​located in the lower right side of the abdomen, just above the pelvic bone. Acute appendicitis can occur in any age group but most commonly affects teenagers and young adults.

What causes acute appendicitis?

In acute appendicitis, the small opening of the appendix is ​​blocked, often by a piece of overcooked food called feces. When the hole is blocked, bacteria that normally live in the colon fills up the appendix. Your immune system responds by sending specialized immune cells called neutrophils to surround and destroy the bacteria. The combination of bacteria and neutrophils leads to the formation of pus.

What are the symptoms of acute appendicitis?

Patients with acute appendicitis usually experience gradual, constant pain that starts near the navel and progresses to the right lower abdomen. Other possible symptoms may include nausea, vomiting, loss of appetite, diarrhea, and fever.

How is acute appendicitis diagnosed?

The diagnosis is made after the appendix is ​​surgically removed and sent to a pathologist for examination under a microscope. If your doctor suspects acute appendicitis, they will order a blood test and x-ray imaging, such as an ultrasound or CT scan. Your blood test usually shows a large number of immune cells called white blood cells (WBCs). An ultrasound or CT scan usually shows an enlarged appendix. Acute appendicitis is most often treated by removing the appendix.

What does acute appendicitis look like under a microscope?

When your pathologist examines your appendix under a microscope, he will look for specialized immune cells called neutrophils in the wall of your appendix. These neutrophils often combine with bacteria to form an abscess (pus). Neutrophils can also be seen on the outer surface of the appendix. Pathologists describe it as periappendicitis.

Observations and tips of this article we have prepared based on the experience of the team, the inflammation observed in acute appendicitis begins on the inside of the appendix, but spreads rapidly, affecting the wall and even the outer part of the appendix. The appendix can also swell, which blocks blood from getting in and out of the appendix. When this happens, parts of the appendix may begin to die due to a process called necrosis.

Acute appendicitis. This low magnification microscopic image shows an appendix with signs of acute appendicitis.

What does perforated appendicitis mean?

If left untreated, a hole or perforation may form in the appendix, and material inside the appendix may enter the abdominal cavity. This release can cause an abscess to form around the appendix.

What does periappendicitis mean?

Periappendicitis refers to inflammation on the outer surface of the appendix. Periappendicitis is a very common finding in acute appendicitis.

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clinical case, patient history of the clinic JSC “Medicina” in Moscow

Surgeon, coloproctologist, oncologist

Skorkina

Irina Konstantinovna

Experience 16 years

Doctor of the highest category, member of the European Society of Surgeons

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Patient S., 45 years old.

Complaints on admission:

pulling pains in the lower abdomen;

nausea;

bloating.

Medical history.

I was sick during the day, when there was pain in the lumbar region, discomfort in the epigastric region, pain in the left hypochondrium.

The ambulance team diagnosed intercostal neuralgia, introduced “Tramadol”, “Baralgin” and “Platifillin” – the pain syndrome was stopped.

On the day of admission, there was pain in the lower abdomen, bloating, fever up to 37.5°C. Notes similar bouts of pain before.

Anamnesis of life.

Chronic calculous cholecystitis.

Chronic iron deficiency anemia against the background of polymenorrhea for several years.

Objectively.

The condition is satisfactory. Skin and mucous membranes of normal color. Pulse 96 beats per minute, rhythmic, good filling. Respiratory rate 18 per minute. Body temperature 37.4°C. Breathing is vesicular, no wheezing. Tongue dry, covered with white coating. The abdomen is swollen, soft, moderately painful above the womb, in the mesogastric region. There are no peritoneal symptoms. Peristalsis is uniform, there are no pathological intestinal noises. Appendicular symptoms are negative. There is no dysuria. The symptom of tapping is negative on both sides. The chair is decorated, regular.

Instrumental and laboratory research.

Chest X-ray – no pathology.

Ultrasound of the abdominal organs – Echo-signs of diffuse changes in the liver (like fatty hepatosis) and pancreas, chronic calculous cholecystitis.

Ultrasound of the pelvic organs – Echo-signs of endometriosis of the uterine body, endocervix cysts, ovarian cysts (endometrioid?), The minimum amount of free fluid in the pelvic cavity.

Complete blood count – hemoglobin 105 g / l, leukocytes – 7.38 × 10 ⁹ g/l, stab – 4%, ESR – 16 mm/h.

Urinalysis – unchanged erythrocytes – 9 in p / sp.

Dynamic observation.

A state without dynamics – pain in the abdomen, more in the left hypochondrium, an increase in body temperature up to 38 ° C. Tongue dry, covered with white coating. The abdomen is swollen, moderately painful above the bosom. There was tension in the muscles of the anterior abdominal wall in the right iliac region. There are no peritoneal symptoms.

Increasing blood leukocytosis from 7×10 ⁹
up to 9×10 ⁹ , stab – from 4 to 8%.

Gynecological consultation.

Apoplexy of a cyst of the left ovary is suspected.

Additional diagnostics.

A CT scan of the abdominal organs was performed – CT signs of calculous cholecystitis.

Moderate signs of lipoid infiltration of the liver.

Indirect signs of pancreatitis.

Differential diagnostic series.

Acute appendicitis.

Apoplexy of a cyst of the left ovary.

Acute cholecystopancreatitis.

Acute appendicitis?

Apoplexy of a cyst of the left ovary.

Acute cholecystopancreatitis.

Indications for surgery – diagnostic laparoscopy.

Impossibility of establishment of the diagnosis by other methods.

The need for emergency intervention in confirming the diagnosis of acute appendicitis.

Progression of symptoms on the background of infusion, detoxification and antibiotic therapy.

The appearance of signs of tension in the right iliac region.

Diagnostic laparoscopy.

Under the ETN, after processing the surgical field, a 10 mm laparoscope was inserted through the umbilical ring. Insufflation CO ₂ . During the revision: in the small pelvis and between the loops of the small intestine, traces of lysed blood were drained. In the right iliac fossa, a loose infiltrate is determined, consisting of the dome of the caecum and the appendix, the latter is destructively changed and fixed to the parietal peritoneum. The infiltrate is divided, the appendix is ​​highlighted to the base. The mesentery was cut off using bipolar coagulation.