Chronic Appendicitis



What is Chronic Appendicitis?

Chronic appendicitis is still the most common surgical emergency encountered, although it is becoming much less common in recent years. Although medical attention and excellent hospital facilities are available throughout this country, 20 Australians still die each year from appendicitis. This should never happen, but often it is a reflection of neglect on the part of the patient, for doctors and hospital staff are well aware of the disasters that lurk in an undiagnosed appendicitis.

The appendix is a short, wormlike structure attached to the caecum, at the junction of the small and large bowel. It usually moves freely in the abdominal cavity. Internally, it has a canal (lumen) that is continuous with the internal cavity of the bowel.



The opening of the lumen may become suddenly blocked with hard bowel material (faecoliths), foreign bodies, inflammation, worms (more common in children) or, more rarely, neoplasms (cancers) of the bowel – this is more probable in older patients. The organ once blocked and infected, rapidly swells, the walls weaken, and they may turn gangrenous and rupture. A surgical emergency may occur in hours.

Chronic Appendicitis Causes

Sometimes a bit of hard material from the bowel jams up the narrow opening of the appendix, allowing infection to occur. Sometimes worms can have a similar obstructive effect. The appendix is a small, elongated organ somewhat like a garden worm extending from the bowel at the caecum, the dilated part where the small intestine joins the large. Normally it moves freely around, although a thin tissue anchors it to the bowel.



Chronic Appendicitis Symptoms

Many variations can occur, but the typical case involves the sudden onset of pain around the navel. This tends to shift after a few hours to the right lower side of the abdominal cavity. Maximum tenderness soon develops over an area referred to as McBurney’s point. When pressed, it may elicit intense pain. Walking and coughing aggravate this pain. Usually there is loss of appetite, probably constipation, perhaps a mild fever. Sometimes diarrhea occurs. There is a general feeling of malaise and being off-color. Appetite is frequently absent. The patient may vomit, without obtaining relief from symptoms.

It is fairly common, although it seems to have lessened a lot in recent years, but it is the most common disorder of the bowel system that requires surgery during childhood. Any age may be involved, the most common being from four to twelve years. But Lancet magazine once reported the successful operation in a baby aged six weeks.



Chronic Appendicitis Treatment

Call the doctor promptly. Appendicitis still kills 60 Australians each year, and in some cases the parent failed to get medical help early. The longer it is left, the greater are the risks of serious, life imperiling complications. The most serious is rupture, allowing masses of germs to infect the whole abdominal cavity. This can cause peritonitis and may be fatal, despite our antibiotics and good nursing techniques.

Do not offer the child food, for if an operation is needed, it is essential that the stomach be empty. Often there is no fever, or possibly a mild one. This is no guide to the seriousness of the disorder.



Surgery carried out by a skilled surgeon in a good hospital usually produces very satisfactory results. The child is often up and around the following day or two, and out of hospital within a few days more, generally less than one week. There is a condition that mimics appendicitis called mesenteric adenitis.

Many cases have been misdiagnosed for appendicitis, the organ removed. However, it is far better for this to happen than the reverse.



Sometimes bladder and kidney infections and chest infections can also mimic appendicitis.

It is essential that with symptoms of this nature immediate medical assistance be called. A missed appendicitis may be fatal, and many cases with such a result are on record.

It is far better to summon the doctor and for it to be something else, than to run the risk of missing the diagnosis. In children a condition called “mesenteric adenitis,” in which glands in the mesentery (the curtain of material attached to the bowel that contains the blood vessels supplying it) become swollen and inflamed, often mimics appendicitis in the young. But just the same it is far better to have the patient professionally examined.

A ruptured appendix can rapidly turn into peritonitis, and this can spread to other parts and convert a mildly ill patient into a critically ill one within hours.



Most cases are not the surgical crisis type, but a significant number are. Others sustain a slower type of inflammation. But the same conditions hold true. Call the doctor promptly if there is any possibility. He or she will carry out further examination, which may include blood tests and a rectal examination to assist in confirming the diagnosis.

In very mild cases, conservative therapy may be suggested. Sometimes starvation with provision of fluids may allow the system to adjust and overcome the infection.

However, in most cases, surgical operation and removal of the affected organ is the line of action. This is safe and simple, especially when carried out early in a well-equipped hospital. Recuperation is prompt.