Definition

Chronic appendicitis refers to long-lasting inflammation of the appendix, a small, finger- or sausage-shaped pouch attached to the large intestine. It occurs if the appendix is inflamed or infected.

Although chronic appendicitis is rare, affecting about 1.5% of all appendicitis cases, it can be difficult to diagnose due to mild and intermittent symptoms. The most common symptom is abdominal pain. Blockages in the appendix are a frequent cause, and prompt diagnosis is critical because chronic appendicitis can become life-threatening in some cases.

Chronic appendicitis may be confused with acute appendicitis. Chronic cases have milder, long-lasting symptoms that come and go, often undiagnosed for weeks, months, or even years. In contrast, acute appendicitis is more severe and develops suddenly, requiring immediate medical attention.

Causes

The exact cause of chronic appendicitis is often unclear. The most common causes include inflammation and partial blockage of the appendix. Other possible causes are:

• Accumulation of feces in the appendix
• Hardened stool deposits (fecaliths)
• Tumors
• Enlarged lymphoid follicles (immune cells in tissues or organs)
• Worm infections
• Injuries or trauma
• Foreign objects such as stones, marbles, or pins that block the appendix

Blockage or inflammation allows bacteria to grow and multiply, causing symptoms. In chronic appendicitis, the blockage is usually partial.

Risk Factors

While appendicitis can affect anyone, certain people may be more prone than others. Risk factors for appendicitis include:

• Age. More common in adolescents and young adults.
• Gender. Men are more likely to develop appendicitis than women.
• Family history. A family history of appendicitis increases the risk of developing chronic appendicitis.

Several factors can raise the risk of chronic appendicitis, but not everyone with these risk factors will develop the condition. For instance, untreated acute appendicitis can increase the likelihood of chronic appendicitis.

Symptoms

Chronic appendicitis symptoms are generally mild, with abdominal pain often being the main indication. The pain is usually located in the lower right side of the abdomen but may start near the navel before shifting. It can vary in intensity, ranging from sharp to dull, though dull pain is more common.

Additional symptoms of chronic appendicitis include:

• Abdominal pain
• Fever
• Tenderness in the abdomen
• Fatigue or lethargy
• Malaise or a general sense of being unwell

Some individuals may also experience nausea or diarrhea, with symptoms that tend to come and go, making diagnosis more challenging. If symptoms worsen, it is important to see a doctor, as they may indicate a more serious health issue.

Differences Between Chronic Appendicitis and Acute Appendicitis

While chronic and acute appendicitis share similar symptoms, they differ significantly. Chronic appendicitis persists for an extended period with intermittent symptoms, leading to prolonged abdominal discomfort for months or even years.

In contrast, acute appendicitis develops suddenly with more severe symptoms, typically within 24 to 48 hours. The pain often starts around the navel and shifts to the lower right abdomen, becoming progressively more intense.

Other acute appendicitis symptoms include:

• Nausea, with or without vomiting
• Mild fever
• Constipation or diarrhea
• Loss of appetite
• Difficulty passing gas

Diagnosis

Chronic appendicitis can be difficult to diagnose due to its mild and intermittent symptoms, which may resemble other conditions. The diagnostic process involves reviewing the patient's complaints and medical history, followed by a physical examination.

To rule out other conditions with similar symptoms, the doctor may order several tests, such as:

• Blood tests
• Pelvic examination
• Pregnancy test
• Urinalysis
• CT scan
• Abdominal ultrasound
• MRI
• Abdominal X-ray

Conditions that may have symptoms similar to chronic appendicitis include: 

• Digestive disorders
• Crohn's disease
• Ulcerative colitis
• Urinary tract infections
• Kidney infections
• Irritable bowel syndrome (IBS)
• Ovarian cysts
• Pelvic inflammatory disease

Management

There are various treatment options for chronic appendicitis. Discuss with your doctor which option is best suited for your condition. Sometimes antibiotics are used, while other times pus may need to be drained from the appendix.

The most common treatment is appendectomy, the surgical removal of the appendix. This can be performed using laparoscopy, which involves small incisions, or laparotomy, which requires a larger incision to open the abdomen. Laparoscopic surgery typically results in fewer complications.

Complications

Chronic appendicitis can lead to complications if not treated promptly, so it’s important to follow medical advice to minimize risks.

Common complications include:

• Acute appendicitis
• Ruptured appendix: This can result in the spread of infection within the abdomen, which may be life-threatening. Immediate surgery is required to remove the appendix and clean the abdominal cavity.
• Abscess: An infection pocket filled with pus, which can be drained via a tube inserted through the abdominal wall. After draining, antibiotics are prescribed, and the appendix may be removed once the infection clears.
• Sepsis: A widespread infection in the body through the bloodstream.
• Peritonitis: Inflammation of the lining of the abdomen.

Do not ignore symptoms of appendicitis. Complications such as a ruptured appendix can lead to serious, life-threatening infections if left untreated. Seek medical help immediately to avoid severe health risks.

Prevention

The prevention of chronic appendicitis remains unclear. Consuming a diet rich in fiber may reduce the risk of appendicitis, although limited research exists on dietary practices specifically aimed at preventing chronic appendicitis. Foods rich in fiber include whole grains, vegetables, and fruits.

Surgical removal of the appendix, known as an appendectomy, can prevent complications such as acute appendicitis or rupture of the appendix.

When to See a Doctor?

You should consult a doctor if you or your child experiences signs or symptoms indicative of chronic appendicitis as previously described. Immediate medical attention is essential for severe abdominal pain.

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