Chronic Appendicitis -Causes,Symptoms, Diagnosis ,and Management

Introduction

Chronic appendicitis is a rare but life-threatening medical condition mainly due to chronic abdominal inflammation and appendix obstruction. The condition's symptoms are not present throughout and may come and go. Also, the symptoms of chronic appendicitis are less severe than acute appendicitis, and a patient usually has persistent but mild abdominal pain, a common symptom of chronic appendicitis. The condition occurs mostly in people who already have untreated acute appendicitis. Therefore, a person experiencing abdominal pain for a long time should consult the doctor immediately to avoid any fatal consequences that may occur due to a worsening condition and get acute appendicitis treated in its initial stages.

What Are the Types of Appendicitis?

Acute Appendicitis: This condition develops within a few days or hours and needs immediate medical or surgical intervention. It is a more common condition than chronic appendicitis, and it occurs among 7 to 9 percent of people 10 to 30 years of age.

Chronic Appendicitis: It is a rare condition that causes inflammation for a long period and usually occurs in 1.5 percent of people already had chronic appendicitis in the past.

What Are the Different Stages of Appendicitis?

The stages of appendicitis are as follows:

• Early.

• Suppurative.

• Gangrenous.

• Perforated.

• Phlegmonous.

• Spontaneous resolving.

• Recurrent.

• Chronic.

What Are the Causes of Chronic Appendicitis?

Chronic appendicitis usually occurs due to various reasons, and the exact cause of many of these conditions is unknown. Chronic appendicitis mainly develops due to pain and inflammation of the appendix. The various causes include:

• Constipation or accumulation of fecal matter.

• Appendix stones or calcified fecal deposits.

• Tumors.

• Worms.

• Abdominal trauma.

• Enlargement of lymph nodes and glands.

• Accumulation of foreign agents such as pins, marbles, and stones.

What Are the Symptoms of Chronic Appendicitis?

Chronic appendicitis is challenging to diagnose as the condition resembles various other medical conditions. A person usually experiences abdominal pain in the lower right side, the only constant symptom they may experience during this condition. In addition, a person may also experience the following symptoms:

• Diarrhea.

• Nausea.

• Fever.

• Abdominal tenderness.

• Severe abdominal pain.

• Weakness and malaise.

• Loss of appetite.

• Tiredness, discomfort, and feeling of illness.

• Difficulty in passing abdominal gas.

All these symptoms may or may not be present in all cases of chronic appendicitis as the symptoms come and go on their own, thus making the diagnosis challenging and complicated. However, if a person recurrently and constantly experiences abdominal pain, they should consult the doctor immediately, as chronic appendicitis can also cause a life-threatening condition. This mainly occurs if symptoms are very severe and treatment is not given on time.

How Is Chronic Appendicitis Diagnosed?

The initial diagnosis of the condition is through a physical examination of the patient. The doctor examines the abdominal region to check for any pain and tenderness. They also ask the patient about the symptoms they may have and their past and present medical history. The doctor may also recommend certain laboratory tests to rule out any differential diagnosis for this condition. The tests may include the following:

• Blood Tests - Complete blood count (CBC) helps detect signs of infection by analyzing the blood samples.

• Pregnancy Test - The test is conducted to rule out ectopic pregnancy, which is often mistaken for appendicitis.

• Pelvic Exam or X-ray - The doctor conducts a pelvic examination to examine the reproductive organs and rules out the cause, such as ovarian cysts or pelvic inflammatory disease.

• Imaging Tests - These help to determine abscesses, signs of inflammation, and other causes that may cause chronic appendicitis: These imaging tests include

  • CT (computed tomography) scan.

  • Magnetic resonance imaging (MRI).

  • Abdominal ultrasound.

What Is the Treatment for Chronic Appendicitis?

After the confirmed diagnosis of chronic appendicitis, the doctor may prescribe antibiotics to treat the abdominal infection. In addition, pus drainage is also advised that forms around the appendix due to chronic appendicitis.

Appendectomy is a treatment method suggested for removing the appendix during chronic appendicitis conditions. Appendectomy is a minimally invasive surgery performed with the laparoscopic surgical technique. The procedure is performed under general anesthesia, also known as keyhole surgery.

When Does Chronic Appendicitis Become Fatal?

Appendicitis requires surgical removal of the appendix to cure pain. The inflammation of the appendix causes pain due to the blockage of the organs. If left untreated, it may cause a burst of the appendix, a life-threatening medical emergency.

What Are the Risk Factors for Appendicitis?

• Age: The condition usually affects people below the age of 20 but can affect people of any age group.

• Family History: People having a family history of appendicitis are more at risk of developing this condition.

• Sex: It is more common in males than females.

What Are the Complications Associated With Chronic Appendicitis?

The complications related to chronic appendicitis include

• Acute appendicitis.

• Inflammation of the abdominal lining and peritonitis. The symptoms of peritonitis include high fever, rapid heartbeat, continuous and severe abdominal pain, and rapid breathing and shortness of breath.

• Ruptured appendicitis.

• Inflammation of the whole body or sepsis due to the chemicals released in the bloodstream. It may cause severe sleepiness, low and high temperature, shortness of breath, and confusion.

• Abscess formation around the appendix.

What Is the Differential Diagnosis for Chronic Appendicitis?

• Urinary tract infection.

• Crohn’s disease - an inflammatory bowel disease affecting the digestive tract’s lining.

• Ovarian cyst.

• Gastrointestinal disorder.

• Ulcerative colitis.

• Pelvic inflammatory disease.

• Kidney infection.

Conclusion

People usually experience acute appendicitis, which can turn chronic if left untreated. The diagnosis of chronic appendicitis is quite difficult, which also delays the treatment time and can further worsen the situation. Since the condition has many differential diagnoses, the doctor should carefully evaluate the case to make a confirmed and clear diagnosis of chronic appendicitis. In addition, a person should not neglect the symptoms of appendicitis and should get immediate treatment if the stomach pain is experienced for a longer duration and take necessary precautions as advised by the doctor.