Chronic Appendicitis: Symptoms, Diagnosis, and Treatment Options

Chronic appendicitis?

Three weeks ago, I underwent an upper gastrointestinal endoscopy, which revealed some inflammation in my stomach and the presence of Helicobacter pylori.
After that, I took a one-week course of a "triple therapy" to eradicate the bacteria.
A few days later, I started experiencing frequent bloating and flatulence.
In the last couple of days, when I lie flat and press a few centimeters to the right of my navel, I feel pain.
If I tap that area, it makes a gurgling sound, but I don't feel any pain unless I press on it.
My bowel movements have been quite normal during this time.
I have seen two doctors; the first one said it probably isn't appendicitis, while the second doctor suggested it might be chronic appendicitis.
Therefore, I would like to ask for your opinion, doctor.
If it is indeed chronic appendicitis, will it get better, or will it eventually progress to acute appendicitis? What methods can be used to diagnose chronic appendicitis (such as abdominal X-ray, abdominal ultrasound, etc.)? By someone who doesn't want to wait until it turns into an acute condition to address it.

Xiao Xin, 20~29 year old female. Ask Date: 2003/11/12

Dr. Liang Jiade reply Gastroenterology and Hepatology

Based on your description, the pain upon pressing the lower right abdomen is likely due to localized abnormal intestinal peristalsis.
It is also possible that it is caused by the use of antibacterial antibiotics, which typically resolves in a short period.
The chronic appendicitis you mentioned is usually a result of recurrent acute appendicitis or incomplete removal of the inflamed appendix during surgery, leading to chronic appendicitis, which is quite rare in clinical practice.
It does not develop from chronic appendicitis into acute appendicitis.
If your symptoms persist, you should seek medical attention for a thorough examination.

Reply Date: 2003/11/12

More Info

Chronic appendicitis is a condition that can often be overlooked or misdiagnosed due to its subtle and variable symptoms. Unlike acute appendicitis, which presents with severe abdominal pain, fever, and nausea, chronic appendicitis may manifest with milder symptoms that can persist over time. In your case, the symptoms you describe, such as localized pain near the appendix area when pressed, along with the history of gastrointestinal issues, could indeed suggest chronic appendicitis.

Symptoms of Chronic Appendicitis
The symptoms of chronic appendicitis can include:
- Intermittent abdominal pain, particularly in the right lower quadrant.

- Nausea or loss of appetite.

- Changes in bowel habits, such as diarrhea or constipation.

- Abdominal bloating or discomfort after eating.

- Mild fever or malaise.

In your situation, the pain you feel when pressing on the area near your navel and the "gurgling" sounds when tapping could indicate inflammation in the appendix. The fact that you have been experiencing gastrointestinal symptoms, including bloating and gas, after your treatment for H. pylori, may also complicate the clinical picture.

Diagnosis
Diagnosing chronic appendicitis can be challenging. Common diagnostic methods include:
- Physical Examination: A thorough physical exam by a healthcare provider can help identify tenderness in the right lower abdomen.

- Imaging Studies:
- Ultrasound: This is often the first imaging test done, especially in younger patients. It can help visualize the appendix and assess for inflammation.

- CT Scan: A CT scan of the abdomen is more definitive and can provide detailed images of the appendix and surrounding structures, helping to confirm or rule out appendicitis.

- X-rays: While not typically used to diagnose appendicitis, they can help rule out other conditions.

Treatment Options
If chronic appendicitis is diagnosed, the treatment typically involves surgical intervention. The standard procedure is an appendectomy, which is the surgical removal of the appendix. This is often performed laparoscopically, which is minimally invasive and allows for quicker recovery times.
In some cases, if the symptoms are mild and not causing significant distress, a doctor may recommend a watchful waiting approach, monitoring the condition closely. However, there is a risk that chronic appendicitis can progress to acute appendicitis, which is a surgical emergency.

Conclusion
Given your symptoms and the potential for chronic appendicitis, it is crucial to follow up with your healthcare provider. They may recommend further imaging studies to clarify the diagnosis. If chronic appendicitis is confirmed, surgical removal of the appendix is generally the best course of action to prevent complications.
It's important to communicate openly with your healthcare team about your symptoms and concerns, especially since you are eager to address this issue before it potentially escalates into an acute condition. Early intervention can lead to better outcomes and a quicker return to normal activities.

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