Chronic appendicitis: symptoms in women. Chronic appendicitis Chronic appendicitis symptoms and treatment in adults

A previously transferred attack of acute appendicitis in women or men in some cases can become chronic, as evidenced by the presence of pathological processes in the appendix. Acute phenomena subside, but the inflammatory process remains, and becomes chronic. This is to distinguish between chronic recurrent appendicitis.

With this form, after an acute attack of appendicitis, pain subsides. After some time, a new attack is observed - a relapse of appendicitis. Therefore, this form is characterized by repeated attacks of acute inflammation of the appendix. In the intervals between attacks, patients experience constant pain in the region of the caecum.

In connection with prolonged inflammation in the appendix, sclerotic changes are observed, its gradual ulceration, deformation, the appearance of adhesions and scars are also possible, which leads to a decrease in the intestinal lumen and even to fusion with nearby organs.

Classification

There are three forms of chronic appendicitis: residual, recurrent, primary chronic.

1. The development of a residual (residual) form of chronic appendicitis occurs immediately after an attack of acute appendicitis, since fertile ground remains in the appendix for the occurrence of repeated attacks.
2. The relapsing form of the disease is characterized by periods of exacerbation and remission.
3. Primary chronic appendicitis is characterized by inflammatory phenomena that develop in an erased chronic form.

The recurrent type of chronic appendicitis usually occurs in those patients who have not been provided with appropriate medical care in the acute course of the disease. In this case, scars and adhesions appear in the tissues of the appendix, the lumen narrows, due to which, when intestinal contents enter here, it stagnates and, as a result, the inflammatory process resumes, which can last for years.

Symptoms of chronic appendicitis

Chronic appendicitis can be accompanied by a blurred picture of symptoms in both women and men. The main symptom of the disease in this case is a regularly occurring aching mild pain in the right side, at the location of the appendix.

Other signs of chronic appendicitis include:

• heaviness, flatulence, the presence of discomfort in the abdomen;
• mild nausea;
• indigestion;
• lack of appetite;
• frequent stool disorders - diarrhea or constipation;
• chronic subfebrile body temperature.

Soreness can increase with heavy exertion (due to increased pressure inside the peritoneum), at the time of emptying, with coughing. There are changes in the work of the digestive tract - constipation and diarrhea. In case of exacerbation, vomiting and nausea occur.

It is very important to diagnose and start treating chronic appendicitis as early as possible, since the constant presence of a focus of infection in the body, of course, does not affect its work in the most favorable way. Moreover, it is fraught with perforation of the appendix with the subsequent development of peritonitis, which can cause the death of the patient.

Chronic appendicitis - symptoms in women

Initially, signs of appendicitis in women are manifested by pain from the gastrointestinal tract. The pain spreads to the right lower abdomen and intensifies during a gynecological examination.

During the period of hormonal changes (for example, during pregnancy or menstruation), the pain is pronounced, localized in the ovaries and vagina. Against the background of appendicitis, failures occur in the cycle. In the process of making love, as well as after it, spasms occur, severe pains in the vaginal area are noted.

Diagnosis and treatment

Since chronic appendicitis is manifested by common symptoms characteristic of a number of other diseases of the internal organs, a complex of laboratory and instrumental diagnostic methods is used to make an accurate diagnosis.

Diagnostic measures to detect chronic appendicitis:

1. Soreness in the right iliac region, increased pain when lying on the left side, when bending the right leg- these signs raise the suspicion of chronic appendicitis. Gangrenous appendicitis may not be accompanied by pain at all due to the death of innervation in the affected tissues. With peritonitis, pain spreads to the entire abdomen.
2. Clinical blood and urine tests. They are not sufficient to make a diagnosis, but they are still important concomitant methods to confirm or exclude the disease.
3. X-ray with contrast agent. This study helps to identify the obstruction of the hole connecting the process with the caecum. Also, radiography can show fibrous adhesions, accumulations of feces.
4. Ultrasound diagnostics. A simple and safe research method that allows you to quickly confirm the diagnosis. During the study, not only the condition of the appendix is ​​assessed, but also other abdominal organs.
5. CT scan. With the help of this study, it is possible to exclude diseases that have similar symptoms.
6. Laparoscopy. A surgical diagnostic method that consists in introducing a thin probe with a camera at the end into the patient's abdominal cavity through a small incision on the anterior abdominal wall. This method not only makes it possible to make an accurate diagnosis, but also allows you to immediately perform the removal of the appendix when an inflammatory process is detected.

Since the symptoms of chronic appendicitis are not specific, it is very important to be able to distinguish this ailment from pathologies of other abdominal organs, in particular:

1. kidney disease;
2. Gynecological diseases.

Treatment of chronic appendicitis is prescribed the same as in the acute form of the disease - surgical removal of the inflamed process. Appendectomy can be performed both laparoscopically and openly - the decision is made by the surgeon depending on the patient's condition and the clinical picture of the disease.

If a patient with chronic appendicitis has unexpressed symptoms, conservative treatment is used - taking antispasmodic drugs, physiotherapy, elimination of intestinal disorders.

Postoperative period

Within two days after the appendicitis was excised, the patient was prescribed bed rest. Antibacterial therapy is prescribed to prevent surgical infections. During this period, nursing care is very important to prevent possible complications.

The suture is removed 10-12 days after the operation. Prior to this, sudden movements, tension of the muscles of the abdominal wall should be avoided in order to avoid eruption of the suture. Recovery of muscle tissue takes several months. A small pale scar remains on the skin, which can be seen in the photo.

The period when you can return to your usual lifestyle depends on the type of appendectomy and the nature of the course of the postoperative period: after endoscopic interventions, healing is faster. On average, physical activity is limited for 2 months, then running, swimming, horseback riding are allowed, and weight lifting - only after 3-6 months. Refrain from visiting the bath or sauna for at least 3-4 weeks.

Diet

With conservative therapy and during the rehabilitation period after surgery, a special diet must be observed:

1. Refuse spices, smoked meats, canned food, sweet carbonated drinks.
2. It is recommended to exclude strong black tea and coffee. It is worth drinking green tea, fruit drinks and compotes.
3. It is necessary to adhere to a fractional diet - 5-6 times a day in small portions.
4. Spicy, salty, fatty, fried foods should be excluded.

As for folk remedies, avoiding a visit to the doctor or inattentively treating the “signals” of your own body in the form of attacks of pain, relying on folk remedies, is strictly prohibited! Herbal medicine and homemade recipes are useful as additional measures to strengthen the body and improve bowel function, as well as in the fight against pathogens.

Disease prevention

There are no special preventive measures. It is recommended to lead a healthy lifestyle, eat rationally, avoid stressful conditions, give up bad habits, lose weight.

Chronic appendicitis is a rare form of flaccid inflammation of the appendix (appendix), which develops after an attack of acute appendicitis and is accompanied by atrophic and sclerotic changes in the appendix wall. The disease is more common in young women. It rarely occurs in children and the elderly.

Forms of the disease

There are three forms of chronic appendicitis:

• residual (residual) form - develops after a previously transferred acute appendicitis, which ended in recovery without surgical intervention;
• primary chronic form - develops slowly, without a previous attack of acute appendicitis. Some experts question its presence, therefore, the diagnosis of primary chronic appendicitis is made only if the presence of any other pathology that can cause a similar clinical picture is excluded;
• recurrent form - symptoms of acute appendicitis recurring in the patient are characteristic, which subside after the transition of the disease to the stage of remission.

At any time, chronic appendicitis can turn into an acute form, and untimely performance of a surgical operation in this case threatens to develop peritonitis, a potentially life-threatening condition.

Causes and risk factors

The main reason for the development of chronic appendicitis is a slow-moving infectious inflammatory process in the appendix.

The development of primary chronic inflammation is promoted by disturbances in the trophism and innervation of the appendix wall, which lead to a decrease in local immunity. As a result, the microorganisms contained in the intestine provoke mild inflammation, which can last for many years, causing discomfort and pain in the right side of the abdomen. Under adverse conditions, a sluggish inflammatory process can be sharply activated, and then acute appendicitis develops.

The main cause of chronic appendicitis is a sluggish infectious process

Secondary chronic inflammation is the outcome of acute inflammation of the appendix. If, for one reason or another, surgical treatment of acute appendicitis has not been performed, very dense adhesions are formed in the appendix, reducing its lumen. This causes stagnation in the appendix of the intestinal contents, which provokes a long-term inflammatory process of insignificant activity.

The recurrent form of chronic appendicitis can be caused by both primary and secondary chronic inflammation. Periods of exacerbation of the disease are provoked by various unfavorable factors (stress, hypothermia, acute infectious diseases), which reduce overall immunity and thereby create prerequisites for enhancing the activity of the inflammatory process in the appendix.

Recurrent chronic appendicitis in very rare cases develops after surgical removal of the appendix (appendectomy). This can happen if the surgeon left a piece of the appendix longer than 2 cm.

Symptoms of chronic appendicitis

The symptomatology of chronic appendicitis is blurred, and sometimes it may be completely absent (during periods of remission with a relapsing form). Typically, patients complain of intermittent aching dull pain in the right iliac region. The pains are of low intensity, but can be aggravated under the influence of gross errors in the diet, intense physical exertion.

Other symptoms of chronic appendicitis are:

• constipation, alternating with diarrhea;
• nausea;
• an increase in body temperature in the evening to subfebrile values ​​​​(37.1 - 37.9 ° C).

In women, a symptom of chronic appendicitis is pain that occurs at the time of mechanical action in the uterine body, for example, during intercourse or gynecological examination using a vaginal speculum.

Pain that occurs during a rectal examination of the prostate may be a symptom of chronic appendicitis in men.

Chronic appendicitis can also be accompanied by the development of vesical manifestations - frequent and painful urination.

With an exacerbation of chronic appendicitis, patients develop a clinical picture corresponding to acute appendicitis.

Diagnosis of chronic appendicitis

Diagnosis of chronic appendicitis is quite difficult, since there are no objective clinical symptoms of the disease. A certain help in the diagnosis is provided by the data of the anamnesis - an indication of the patient to one or more attacks of acute appendicitis he has suffered.

Indirect signs of chronic appendicitis may be weakly positive (without exacerbation) symptoms of Sitkovsky, Rovsing, Obraztsov, as well as the presence of a zone of local pain in the right iliac region.

Chronic appendicitis is more often detected in young women. It rarely occurs in children and the elderly.

If chronic appendicitis is suspected, irrigoscopy (X-ray of the large intestine with contrast) is performed. This reveals the following changes:

• narrowing of the lumen and deformation of the appendix;
• incomplete filling of its lumen with contrast;
• delayed emptying (contrast removal).

To exclude neoplasms in the colon and caecum, colonoscopy is indicated, as well as ultrasound scanning and plain radiography of the abdominal cavity.

Laboratory diagnosis of chronic appendicitis is not very informative, since changes are usually not detected in clinical blood and urine tests, or they are associated with some other pathology.

Differential diagnosis of chronic appendicitis is carried out with the following diseases:

• gynecological diseases;
• diseases of the urinary tract;
• ileotiphlitis and typhlitis;
• abdominal ischemic disease;
• peptic ulcer of the stomach and duodenum.

Treatment of chronic appendicitis

If the diagnosis of chronic appendicitis is not in doubt and the patient has a persistent pain syndrome, an appendectomy is performed - an operation to remove the appendix using a laparoscopic or traditional (open) method.

If there is doubt about the presence of chronic appendicitis, one should refrain from performing an appendectomy, since the removal of an unchanged process in the future usually only aggravates the severity of the pain syndrome that served as the basis for surgical intervention.

Treatment of chronic appendicitis with unexpressed symptoms is conservative. Patients are prescribed antispasmodic and anti-inflammatory drugs, physiotherapy procedures.

Possible consequences and complications

Long-term chronic appendicitis leads to the development of adhesions in the abdominal cavity, which, in turn, can cause intestinal obstruction.

At any time, chronic appendicitis can turn into an acute form, and untimely performance of a surgical operation in this case threatens to develop peritonitis, a potentially life-threatening condition.

Forecast

The prognosis for timely treatment of chronic appendicitis is favorable.

Prevention

There are no special measures for the prevention of chronic appendicitis. It is necessary to adhere to a healthy lifestyle (proper nutrition, giving up bad habits, playing sports, observing the regime of work and rest), which allows you to increase the activity of the immune system and thereby reduce the risk of inflammation in the appendix.

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both is a disease with a specific clinical picture, which is based on primary or secondary chronic inflammatory changes in the appendix of a non-specific nature.

There are three main clinical forms of chronic appendicitis.

Residual, or residual, appendicitis occurs as a result of the regression of acute appendicitis. With this form, focal or diffuse morphological signs of chronic inflammation can be found in the wall of the appendix.

Chronic recurrent appendicitis occurs with periodic exacerbations and remissions. Its appearance is usually preceded by repeated attacks of acute appendicitis.

These forms are very similar, are secondary and are often combined under the name of chronic recurrent appendicitis. In cases where the disease is characterized by a gradual, unflappable onset and course, it speaks of primary chronic appendicitis.

Clinic of chronic appendicitis

subject to great variability and polymorphism. Often, residual chronic appendicitis occurs with symptoms resembling a sluggish form of acute inflammation of the appendix. Most often, patients complain of pain in the right iliac region or the right half of the abdomen of a constant or paroxysmal nature. In some cases, there is irradiation of pain in the lower back, inguinal region, bladder, right thigh, which is explained by the different localization of the appendix and the presence of adhesive periappendicitis. Walking, running, physical activity, increased intra-abdominal pressure when coughing, sneezing, defecation often contribute to increased pain or provoke them. Some patients note the connection of pain with errors in the diet. There are also various disorders of the gastrointestinal tract (nausea, vomiting, constipation, rarely diarrhea).

During an objective examination, it is often possible to note pain in the right iliac region with deep palpation, as well as positive symptoms of Sitkovsky and Rovsing. In the blood and urine of most patients, pathological changes are not observed. Body temperature remains within the normal range.

Diagnosis of chronic appendicitis

is not always easy. This is due to the absence of pathognomonic signs that make it possible to distinguish the latter from other similar diseases of the abdominal organs. The solution of the problem is facilitated in the presence of one or more attacks of acute appendicitis in history. A certain clarity in the diagnosis can be made by X-ray examination of the ileocecal angle after taking barium through the mouth and barium enema. Prolonged stagnation of the contrast agent in the appendix, its pronounced deformation, as well as limited filling indicate chronic appendicitis. Differential diagnosis is carried out to exclude the mobile caecum, gastric ulcer and duodenal ulcer, chronic cholecystitis, nephrolithiasis, pyelitis, helminthic invasion, nonspecific meseitherial lymphadenitis, and in women - chronic adnexitis. Only a consistent, purposeful exclusion of these diseases makes it possible to substantiate the diagnosis of chronic appendicitis.

Treatment

is to remove the appendix. The operation is not fundamentally different from appendectomy in acute inflammation. Postoperative complications are rare. These include suppuration of the postoperative wound (1-3%), pneumonia, thrombophlebitis, sometimes local and diffuse peritonitis. Mortality after appendectomy in chronic appendicitis is less than 0.05%. Good long-term results are observed in 65-90% of cases.

Chronic appendicitis is an inflammation of a long-term nature, which is localized in the area of ​​​​a small worm-like area of ​​\u200b\u200bthe caecum.

The disease can be primary or secondary. Most often, its cause is an untreated acute form of the disease. In order to prevent complications of the disease, at the first signs of it, it is recommended to visit a doctor and get advice on treatment.

Differences between chronic and acute appendicitis

The presence of a chronic form can be determined by the following signs:

• An attack of pain occurs quickly, but just as quickly it can pass on its own. The acute course is different in that the sensations increase gradually and only analgesics can relieve pain.
• The temperature during a sluggish process usually does not rise much, it can remain within 37.5 degrees, while the pulse remains unchanged.
• It is quite difficult to identify a chronic pathology by a blood test. In an acute course, leukocytosis rapidly increases. And in the first case, the number of leukocytes remains normal, only a slight increase in the indicator can be observed.
• If there is no hospitalization and treatment when pain occurs, the attack may disappear on its own. The disease continues to remain in a sluggish state. Acute appendicitis without treatment can end in failure, perforation of the appendix.

The chronic form can gradually turn into an acute one, but this occurs quite rarely. Pain during an attack of a sluggish process is localized immediately to the right of the lower abdomen.

With an exacerbation, discomfort is observed first in the stomach and umbilical zone, gradually moving to the right side of the lower abdomen. Vomiting, nausea, loose stools, weakness can be observed in both cases.

Classification of sluggish appendicitis

To determine in what form the inflammation of the appendix takes place, certain principles of comparison are applied.

Chronization of the process occurs when inflammation of this part of the caecum persists for a long time. Sometimes this may be due to acute appendicitis that has not been cured by surgery.

The classification of the chronic course of appendicitis distinguishes 3 forms of the disease:

• Recurrent phase of appendicitis. Inherent in patients who have repeatedly experienced bouts of pain on the right side of the abdomen.
• Residual form. The diagnosis can be established if the pain attack was observed once.
• The impregnable phase. It is considered the primary sign of pathology, when there was no pain in this area before.

We can say that there is a primary form of the disease, it includes an inaccessible phase and a secondary one, which includes residual and recurrent forms. With a pathology of a recurrent nature, an exacerbation may periodically occur. The residual phase appears most often when an acute attack of appendicitis is stopped..

Manifestations of the disease

Symptoms of the disease usually have a blurred picture. The main symptom is aching pain in the right side - in the area where the process of the caecum is located. In addition, the patient may experience:

• Flatulence, discomfort, heaviness.
• Nausea, vomiting.
• Indigestion.
• Decreased or complete lack of appetite.
• Violation of the stool, periodic change of diarrhea and constipation.
• Prolonged insignificant increase in body temperature.

Physical activity can increase pain in the appendix area, this is due to an increase in intra-abdominal pressure. Also, the symptoms may become brighter when you cough or have a bowel movement.

With exacerbation, vomiting is often observed.

Causes of the disease

Most often, the acute form occurs when the appendix is ​​blocked by feces, the penetration of foreign bodies into the intestine. The chronic form is usually the result of an untreated acute illness, with periodic exacerbations and remissions.

The main reasons for the chronization of the process are:

• Violation of the hematopoietic system.
• Diseases of the digestive tract.
• Pathology of the endocrine system.
• Weakened immunity.
• Heredity.
• Chronic constipation.

Provoking factors may be the abuse of bad habits, overwork, hypothermia, the presence of excessive body weight, physical activity.

Diagnostics

The final diagnosis can be made only after passing a special examination. For this, appoint:

• Abdominal ultrasound.
• CT, which helps to exclude the presence of a tumor.
• Laparoscopy.
• Radiopaque irrigoscopy. This study allows you to obtain information about the presence of deformation, narrowing of the lumen, the shape of the process.

General diagnosis should include blood and urine tests.

Features of pathology in women and men

Most often, this disease is diagnosed in women. This is due to their physiological structure. The main signs of the disease in the weak half of humanity are:

• Cramping pains in the lumbar region.
• The presence of discomfort or discomfort, heaviness in the vaginal area. At the same time, it is quite difficult to understand how the appendix hurts during the menstrual cycle or during intercourse, since there is a temporary increase in all sensations.
• Lack of appetite.
• Dyspeptic disorders.
• Increased number of trips to the toilet.
• The presence of discomfort after exercise or eating junk food.

In men, the attack begins with the appearance of dull pain in the right side of the abdomen, while the sensations are pulling. Increased discomfort occurs with physical activity or coughing. Rarely there is pain in the hypochondrium on the right side. When the patient takes the position lying on the right side, the discomfort recedes. Dyspeptic syndrome in men is usually more pronounced than in women.

In adults, the chronic form is much more common than in childhood.

Features of the course of sluggish appendicitis in children

Most often, pathology in children is due to anomalies in the development of the process. According to the symptoms, the disease resembles intestinal colic, so it is very difficult to determine the presence of the disease in children.

Parents should suspect something is wrong if the child is constantly lethargic, suffers from chronic constipation and periodically has a rise in temperature without other signs of illness.

The chronic course of the disease in children is rarely diagnosed due to age-related underdevelopment of the valve responsible for closing the entrance to the process, which minimizes the possibility of stagnation in the lumen.

Pregnancy and sluggish appendicitis

When carrying a child, the appearance of pathology is explained by the growth of the uterus due to an increase in the fetus, which leads to compression and displacement of the peritoneal organs. In addition, the pressure on the genitourinary system increases.

The complexity of diagnosis lies in the fact that the symptoms may be similar to problems of a urological and gynecological nature and do not always attract the attention of doctors.

During pregnancy, there is a high risk of transition of a chronic process into an acute form.

Therapy Methods

Measures to eliminate the pathology are prescribed by the doctor during a preliminary examination of the patient. Treatment without surgery is possible in the absence of severe pain and various complications. In other cases removal of a shoot is shown. It must also be excised during pregnancy, preferably in the first trimester.

Medical impact

Conservative treatment includes taking appropriate medications and following the recommended diet. If the patient has an exacerbation of the disease, then it can be stopped after taking an antispasmodic drug.

In addition, it is often prescribed:

Treatment with home methods

As additional means to strengthen the immune system and stabilize the intestines, folk remedies can be prescribed. The most effective are:

When is the operation scheduled?

Many people wonder if it happens that the operation is prescribed for chronic appendicitis without medical treatment.

For example, inflammation of the appendix during childbearing can cause serious disturbances in the development of the fetus. Having a pathology, it is better to remove the appendix in the first trimester in order to exclude the possibility of harm to the mother and child later in pregnancy. In addition, appendectomy is prescribed for patients with adhesions and scars..

Surgery can be performed in two ways - classical and endoscopic.

These methods include:

• Typical appendectomy. An incision is made in the right iliac region, the process is brought into it. After ligation of the mesentery, the appendix is ​​retracted. After that, the stump is sutured and returned back to the caecum.
• Retrograde appendectomy. Such an operation is indicated for patients with adhesions, when the possibility of withdrawing the process into the surgical wound is excluded. The appendix is ​​cut off from the intestine, while the stump is sutured with subsequent return to the intestine. The process is isolated gradually by bandaging its mesentery.

Endoscopic methods include:

• Laparoscopic appendectomy. Through small punctures in the walls of the abdomen, the inflamed appendix is ​​cut off and removed.
• transluminal appendectomy. In this case, the incision is made not in the abdomen, but in the stomach or vagina. This avoids stitches, as in conventional surgery. This technique also helps to shorten the recovery period.

Postoperative period

After surgery, the patient should abstain from food for two days. Antibiotics are prescribed to prevent infection. Sutures are removed after 10-14 days.

The patient is prohibited from sudden movements, muscle tension, because this can lead to divergence of the seams. Full recovery occurs within two to three months.

If the operation occurs endoscopically, then the postoperative period passes much faster and the seam is almost imperceptible.

You can do physical work no earlier than two months after the operation. Within a month after the procedure, the patient should not visit the bath.

Diet and proper nutrition

If a conservative path of treatment is chosen, then the patient needs to reconsider his diet. Following a special diet can help get rid of problems without surgery.

It is recommended to avoid smoked, spicy, canned, sweet foods. Soda is contraindicated. The diet provides for the rejection of coffee and strong black tea. It is useful to drink fruit drinks, compotes, green tea.

You should eat 6 times a day, while portions should be fractional.

Complications in the chronic course of appendicitis

If you refuse to treat the chronic form of the disease, then it can gradually turn into an acute one. In addition, other complications of the disease are often observed, such as:

• Appearance of appendicular infiltrate. In this case, the patient is shown anti-inflammatory, painkillers, antibiotics, physiotherapy, cold. When the process is stopped, the appendix should be removed.
• Abscess of the appendicular infiltrate. It can be eliminated only by surgery, while the abscess is drained. Removal of the process is possible only a few months after the procedure.
• The appearance of adhesions. Depending on the volume and neglect, the process can be treated both surgically and physiotherapy.

Answering the question of whether chronic appendicitis is removed only through surgery, it should be noted that the doctor chooses the method of treatment. At the same time, he takes into account the presence of complications, such as adhesions, the nature and frequency of pain attacks, the age of the patient, the degree of neglect of the pathology.

When choosing a conservative method of treatment, a number of drugs and a special diet are prescribed. It is possible that after undergoing medical treatment, the patient will need to be operated on.

Chronic appendicitis (CA) is a rare form of inflammation of the appendix, leading to its atrophic changes. It is characterized by a sluggish course and poor symptoms. It is a consequence of a previously transferred acute appendicitis, after which changes remain in the form of adhesive processes with neighboring tissues and scars. Occurs in 5-15% of all cases of appendicitis. Equally often affects men and women.

Types of chronic appendicitis

It is customary to distinguish three forms of chronic appendicitis:

• chronic residual (residual);
• chronic relapsing;
• primary chronic.

Residual is characterized by a single attack in history, recurrent - two or more. Primary chronic is rarely diagnosed, and not all experts agree with this formulation. This type of chronic appendicitis does not develop acutely, but gradually. There is no history of acute attack.

Causes of chronic appendicitis

After acute attacks of appendicitis, adhesions, scars, deformities occur, which complicates the self-cleaning of the appendix. Violation of blood circulation in this area leads to the activation of pathogens. This supports the inflammatory process, chronizing appendicitis.

Stages of chronic appendicitis

Conventionally, three stages can be distinguished:

1. Severe pain that appears sharply and suddenly disappears, or unexpressed painful sensations, but last longer.
2. Repeated attack or transition to a chronic form.
3. The gradual progression of the disease and the increase in clinical symptoms, followed by aggravation of the condition and the development of complications.

Symptoms of chronic appendicitis

Chronic appendicitis can develop in different ways.

The clinical picture is blurred and poor. The symptoms of chronic appendicitis in men do not differ from the symptoms of chronic appendicitis in women. First, there is a feeling of discomfort in the right iliac region. Aching pains may occur, especially after lifting weights.

Vaginal, rectal, and urological symptoms may also be observed.

Diagnostics

Diagnosis of chronic appendicitis is often difficult because the disease does not have specific clinical manifestations, pathognomonic signs. In a relapsing form, the disease is easier to diagnose. The doctor relies on the results of a physical (physical) examination, clinical and anamnestic data (the presence of previously occurring acute attacks) and an instrumental study - radiopaque irrigoscopy.

The general plan for the diagnosis of chronic appendicitis:

1. Collection of anamnesis.
2. Exclusion of somatic diseases of the abdominal cavity and small pelvis, the manifestations of which can be mistaken for symptoms of chronic appendicitis. According to indications - kidney examination, urography, rectal and vaginal examination, etc.
3. Examination of the respiratory organs (according to indications - fluoroscopy).
4. Examination of the cardiovascular system, which includes measuring the pulse, blood pressure (according to indications - ECG).
5. Physical examination of the abdomen, including palpation and percussion to detect appendicular manifestations.
6. Temperature measurement.
7. General analysis of blood and urine, although the results of these tests often do not have pronounced changes.
8. visualization methods.

In the event of a repeated acute attack, it is not an exacerbation of a chronic one that is diagnosed, but an acute appendicitis.

Physical examination

Palpation is one of the methods of physical examination.

1. Draws attention to pain in the right iliac region, as well as muscle tension, which is a reflex defense reaction to the mechanical impact of the painful area.
2. Soreness at McBurney's point on slight tapping with the finger.
3. Bimanual palpation is performed to reveal the soreness of a deep-lying focus. To obtain more accurate information, it is necessary to fix the organ with one hand and apply it to the other, palpating hand.

Instrumental diagnostics

If the picture of chronic appendicitis is typical (which happens infrequently, unlike acute), then they operate without a preliminary X-ray examination. Imaging techniques are used when the diagnosis is unclear. This may be a survey radiography, sonography, computed tomography, a contrast study of the gastrointestinal tract.

After acute attacks of appendicitis, adhesions, scars, deformities occur, which complicates the self-cleaning of the appendix.

In the case of chronic appendicitis, it is mandatory to conduct an X-ray contrast irrigoscopy of the large intestine, the results of which can be used to judge the condition of the appendix. Colonoscopy allows to exclude the presence of oncopathologies in the caecum and large intestine, and radiography and ultrasound diagnostics - in the abdominal cavity.

Differentiate chronic appendicitis from the following diseases:

1. Diseases of the genitourinary system. Renal colic, nephrolithiasis, pyelitis, pyelonephritis.
2. Gynecological disorders. Ectopic pregnancy, ovarian cystomas, ovarian apoplexy, inflammatory processes in the organs of the female reproductive system.
3. Pathology of the gallbladder and pancreas. Pancreatitis, cholecystitis, cholelithiasis.
4. Intestinal diseases. Enteritis, enterocolitis, ileitis, diverticulitis, acute intestinal obstruction, intestinal oncopathology, irritable bowel syndrome.
5. Diseases of the stomach. Gastritis, peptic ulcers, poisoning.
6. Other pathologies simulating CA. For example, diseases of the cardiovascular system, pleurisy, lobar pneumonia, pelvic peritonitis, tuberculous mesoadenitis.

Treatment

In many cases, surgical treatment is indicated by open appendectomy or by laparoscopy. During the operation, other organs of the abdominal cavity are examined for other causes of pain. During the recovery period, antibiotics are prescribed. The likelihood of developing adhesive processes is high.

If the symptoms are practically not expressed, conservative methods are sufficient - the appointment of antispasmodics, physiotherapy. The doctor may not detect visible changes in the process due to mild severity. In such cases, the operation performed can worsen the condition and increase the pain, which became the basis for an appendectomy.

Complications

The pathogenesis of chronic appendicitis is complex, so diagnosis is difficult. Having survived one or more attacks, a person does not go to the doctor while he develops CA. The risk of death is high, especially in people over 60 years of age. They have a more blurred clinical picture than patients of other ages. The following complications may develop:

• at the initial stage, there is an infiltration of inflammatory exudate around the affected process;
• abscess, peritonitis;
• in the later stages, sepsis develops, infection enters the systemic circulation, spread to nearby organs.

Features of chronic appendicitis in children

In children, the disease is more severe than in adults. At the same time, diagnosis is difficult due to the morphological and physiological characteristics of a growing organism. Purulent-inflammatory processes spread faster in the abdominal cavity due to insufficient development of the omentum and lymphoid tissue of the appendix. Due to the anatomical features of the process in children, blockage occurs more often than in adults.

In many cases, surgical treatment is indicated by open appendectomy or by laparoscopy.

Features of chronic appendicitis in pregnant women

Symptoms of chronic appendicitis are either erased or completely absent. Diagnosis in pregnant women is especially difficult due to the displacement of organs. Inflammation can significantly affect the mother and child, therefore, in most cases, if appendicitis is suspected, hospitalization and surgical treatment are indicated.

Features of chronic appendicitis in the elderly

In people over 65 years of age, the signs are practically not expressed, therefore they are ignored by patients for a long time. The main feature of CA in the elderly is that the degree of damage to the appendix and the severity of clinical manifestations do not correspond to each other.

Often the pain is insignificant, the temperature is normal (sometimes subfebrile condition), the process does not become obstructed, with deep palpation there is practically no pain. The data of laboratory blood tests in most cases demonstrate a significant shift of the leukocyte formula to the left.

Forecast

The prognosis is conditionally favorable. You should hope for a good outcome if the disease was correctly diagnosed and treated in a timely manner. The risk of complications depends on the form of appendicitis, the duration and nature of the course. Mortality is 0.07%, and complications develop in every tenth.

Preventive measures

To avoid chronic appendicitis, you should consult a doctor after the first attack, do not delay treatment.

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