Appendicitis involves the inflammation of the appendix, a small, finger-shaped pouch connected to the large intestine. While commonly recognized for its acute, sudden onset, appendicitis can also manifest in a persistent or recurring form. This less common presentation requires a distinct understanding.
Understanding Appendicitis: Acute vs. Chronic
Acute appendicitis is characterized by a sudden, severe inflammation, often developing rapidly over 24 to 48 hours. This typically results from a complete obstruction of the appendiceal lumen, usually by hardened stool, foreign objects, or swollen lymphoid tissue. Such a complete blockage causes pressure to build within the appendix, leading to rapid inflammation and potential complications if not promptly addressed.
Chronic appendicitis, in contrast, involves persistent or recurring inflammation over an extended period, which can range from weeks to months, or even years. This form is often linked to a partial or intermittent obstruction of the appendiceal lumen. When the blockage is partial, pressure might build up and then subside, causing symptoms to wax and wane. Although it is less frequently encountered than acute appendicitis, accounting for approximately 1% to 1.5% of all appendicitis cases.
Recognizing Chronic Appendicitis Symptoms
The symptoms of chronic appendicitis are often milder and less distinct compared to the severe, sudden pain associated with acute cases. Individuals typically experience recurrent abdominal pain, most commonly in the lower right side of the abdomen. This pain may present as a dull ache or occasionally as sharp discomfort, and it can persist or come and go over days, weeks, or even months.
Other common symptoms can include nausea, bloating, indigestion, and occasionally a low-grade fever. Some individuals might also experience fatigue. The intermittent nature of these symptoms can make diagnosis challenging, as they might subside on their own only to return later, sometimes leading to confusion with other gastrointestinal issues.
Diagnosing Persistent Appendicitis
Diagnosing chronic appendicitis can be more complex than diagnosing acute cases due to the less specific and fluctuating nature of its symptoms. Diagnosis typically begins with a physical examination and a review of the patient’s medical history. The physical exam may involve checking for tenderness in the abdomen.
Blood tests are often conducted to check for signs of infection, such as an elevated white blood cell count, although this elevation might be less pronounced than in acute appendicitis. Imaging studies are also crucial. A computed tomography (CT) scan is effective for visualizing the appendix and identifying inflammation or obstruction. An abdominal ultrasound or magnetic resonance imaging (MRI) may also be used. Diagnosis frequently involves ruling out other conditions with similar abdominal symptoms, such as urinary tract infections, Crohn’s disease, or irritable bowel syndrome.
Management and Treatment Approaches
Once chronic appendicitis is diagnosed, the primary treatment involves surgical removal of the appendix, known as an appendectomy. While chronic appendicitis does not present as an immediate emergency like its acute counterpart, surgical intervention is generally recommended. This approach aims to alleviate the persistent symptoms and prevent potential complications, such as an acute flare-up or abscess formation.
The appendectomy can be performed using either laparoscopic surgery or traditional open surgery. Laparoscopic surgery is a minimally invasive technique that involves small incisions. Antibiotics may be prescribed to manage infection, or an abscess may be drained before surgery. Removing the appendix is the definitive treatment to resolve chronic appendicitis and prevent future recurrences.