Chronic appendicitis refers to the chronic inflammatory changes in the appendix that persist after the acute inflammation subsides, such as fibrous connective tissue proliferation in the wall, narrowing or occlusion of the lumen, distortion of the appendix, and adhesion to surrounding tissues.

bubble_chart Clinical Manifestations

The main clinical manifestation is dull pain in the right lower abdomen that is not obvious or irregular, occasionally accompanied by other digestive symptoms such as increased frequency of bowel movements or abdominal bloating. Grade I tenderness in the right lower abdomen is the primary sign.

bubble_chart Diagnosis

Chronic appendicitis lacks typical clinical manifestations and can cause right lower abdominal pain and tenderness. There are many disease causes, and the diagnosis of chronic appendicitis should pay attention to the following points:

1. A history of typical acute appendicitis: Recurrent cases often have a history of severe acute appendicitis. The medical history should include a typical episode of acute appendicitis, and a history of appendiceal abscess or inflammatory mass is of greater diagnostic value.

2. Recurrent right lower abdominal pain and tenderness: Thickening of the appendiceal wall, narrowing of the lumen, and obstruction of emptying can easily induce acute infection or residual infection, often causing right lower abdominal pain and tenderness. The location of abdominal pain and mild tenderness caused by chronic appendicitis should be the same as in previous acute appendicitis, differing only in severity.

3. X-ray barium meal examination: This is a very important examination. Especially in cases without a typical history of episodes, barium meal examination can not only confirm that the tenderness point is located at the appendix but also rule out other conditions. The X-ray signs of chronic appendicitis include interruption, distortion, delayed emptying of the appendix, and difficulty in movement due to adhesions. If the appendiceal lumen is completely blocked, it will not be visualized, and the relationship between the tenderness point and the appendix can be judged based on the position of the ileocecal region.

bubble_chart Treatment Measures

The treatment of chronic appendicitis is primarily appendectomy. If significant adhesions are anticipated or the diagnosis is not entirely clear, a right lower midline rectus incision should be used to improve exposure and facilitate exploration of other organs.

After appendectomy, symptoms such as abdominal pain caused by chronic appendicitis should disappear immediately. If preoperative symptoms persist, further examination is necessary to determine the disease cause of the abdominal pain.