GastroIntestinal / Gastroenterology

Chronic appendicitis: What you need to know

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.

What is chronic appendicitis?

The appendix - chronic appendicitis
The 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.


Causes

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

Symptoms

Chronic appendicitis
Mild 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.


Chronic vs. acute appendicitis

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.

Diagnosis and treatment

two surgeons at work in operating theatre performing facial surgery
An 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:

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.


Complications

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.

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