What Is Chronic Appendicitis?

Chronic appendicitis refers to chronic inflammation of the appendix after the acute inflammation of the appendix subsides, such as hyperplasia of fibrous connective tissue in the wall of the tube, narrowing or occlusion of the lumen, distortion of the appendix, and adhesion to surrounding tissues. There are two types of chronic appendicitis: primary and secondary. The onset of primary chronic appendicitis is insidious, the symptoms develop slowly, intermittent attacks, and the duration of the disease is longer, months to years. There was no typical history of acute attacks at the beginning of the disease, and there was no recurrence of acute attacks during the course of the disease. Secondary chronic appendicitis is the first onset of acute appendicitis to heal or resolve on its own after non-surgical treatment. After that, there are clinical symptoms that remain untreated for a long time. The course can be repeated or multiple acute attacks.

Basic Information

English name

chronic appendicitis

Visiting department

General surgery

Multiple groups

Children, elderly

Common causes

Appendiceal wall stenosis, foreign body in the appendix cavity, etc.

Common symptoms

Pain or swelling in the right lower abdomen, indigestion, decreased appetite, etc.

Contagious

no

Clinical manifestations of chronic appendicitis

Abdominal pain

Pain in the right lower abdomen is characterized by intermittent faint pain or bloating. Most patients induce abdominal pain after full meals, exercise, fatigue, cold and standing for a long time. There may be acute episodes of chronic appendicitis in the course of the disease.

2. Gastrointestinal reaction

Patients often have indigestion of varying severity and decreased appetite. Those with a longer course may experience weight loss and weight loss. There is generally no nausea and vomiting, and no bloating, but elderly patients may be accompanied by constipation.

3. Abdominal tenderness

Tenderness is the only sign, which is mainly located in the lower right abdomen. Generally, the tenderness is small and the position is constant. There is no muscle tension and rebound pain. Generally there is no abdominal mass, but sometimes the cecum can be touched.

4. Indirect signs

A variety of specific tender points such as Mai's point, Lan's point, psoas muscle sign, and Roche's sign are not necessarily present in the diagnosis of chronic appendicitis.

Examination of chronic appendicitis

1. X-ray barium enema examination

Examination of barium enema can not only determine whether the tenderness point is located at the appendix, but also important to exclude other diseases that can be confused with chronic appendicitis, such as ulcers, chronic colitis, cecum tuberculosis or cancer, and visceral droop. This test is important for patients without a history of typical attacks.

2. Ultrasound

It is used to exclude chronic cholecystitis, chronic mesenteric lymphadenitis, chronic appendicitis, chronic urinary infection, and urinary stones that are most likely to be confused with chronic appendicitis.

Diagnosis of chronic appendicitis

The diagnosis of chronic appendicitis is not easy, and its diagnosis must first exclude all diseases that can cause pain and tenderness in the right lower abdomen. For patients who have had a history of acute appendicitis and who have repetitive (intermittent) paroxysmal appendicitis with obvious symptoms in the future, the diagnosis is not difficult; for chronic (obstructive) appendicitis without a history of acute appendicitis, barium enema examination is helpful.

Treatment of chronic appendicitis

After the diagnosis of chronic appendicitis is confirmed, surgery should be performed in principle, especially in patients with a history of acute attacks. For patients with suspicious diagnosis or elderly patients with severe comorbidities, conservative treatment should be temporarily suspended and the condition should be closely observed.