Chronic appendicitis

What are acute and chronic appendicitis?

Appendicitis is inflammation of the vermiform appendix, which occurs in all age groups (Figure 1). Acute appendicitis is an acute condition that develops rapidly, over several hours, and is characterised by progressive pain in the lower right abdomen, accompanying fever, nausea, and bowel movement disturbances. In cases of acute appendicitis, surgical treatment – appendectomy – is most often performed. If acute appendicitis is treated medically, it may recur after some time (~30% of cases, most often during the first year) or so-called chronic appendicitis may develop. Recurrent exacerbations of appendicitis usually have a more severe course and more often cause complications. Chronic appendicitis is characterised by periodic or persistent mild pain in the area of the caecum, nausea, and sometimes bowel movement disturbances.

Why does chronic appendicitis develop?

Chronic appendicitis develops when acute inflammation in the caecal appendix does not resolve completely or recurs several times, causing a prolonged, less pronounced inflammatory process. Repeated subacute episodes of inflammation cause wall thickening and scarring, resulting in impaired drainage of mucus from the vermiform appendix. It may also be partially obstructed by faecal stones (faecaliths) or lymph nodes, which may enlarge as a result of prolonged irritation. Unlike acute appendicitis, the obstruction is not complete, therefore the symptoms are milder but prolonged.

How is chronic appendicitis diagnosed?

The diagnosis of chronic appendicitis is difficult because its symptoms are non-specific; therefore, other possible diseases must also be excluded. Most often, the diagnosis is made by performing computed tomography of the abdominal cavity or, in selected cases, diagnostic laparoscopic surgery, during which, if the diagnosis is confirmed, treatment (appendectomy) is also performed.

What treatment is used?

In chronic appendicitis, the only treatment is surgical – laparoscopic appendectomy is performed. The operation is performed laparoscopically, and during it the vermiform appendix is separated and removed (Figure 2).

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