Understanding Chronic Appendicitis

Inflammation of the appendix can last for years and may require surgery

Medically reviewed by Robert Burakoff, MD

Chronic appendicitis is appendicitis that lasts for longer than a week. People with chronic appendicitis have pain in the lower-right part of the abdomen that may persist or come and go over time. How long you can have chronic appendicitis varies. For some, it lasts months. For others, years.

Chronic appendicitis is uncommon. Researchers believe it only accounts for between 1% and 1.5% of all cases of appendicitis.

This article discusses chronic appendicitis, including how it differs from acute cases, what causes it, how it is diagnosed (and why it's often misdiagnosed), and how it is treated.

What Are the Symptoms of Chronic Appendicitis?

Chronic appendicitis is long-term inflammation of the appendix, the small pouch extending off the large intestine. It is typically milder than acute or sudden-onset appendicitis. Chronic appendicitis lasts for seven days or more and can come and go for weeks, months, or years.

People with chronic appendicitis usually have mild to moderate pain on the lower right side of the abdomen. It may spread to the belly button and can feel dull or sharp. Other symptoms may include:

• Abdominal swelling

• Fatigue or feeling generally unwell

• Gastrointestinal symptoms such as diarrhea or nausea

• Fever

It is possible to have chronic appendicitis with only mild symptoms or no symptoms at all. Because of this, people don’t always seek medical care.

If you do experience symptoms, it is important to seek medical care right away, since chronic appendicitis can become life-threatening.

Related: Early Signs of Appendicitis

Chronic vs. Acute Appendicitis

Chronic appendicitis is different than acute appendicitis, the more common type. Acute appendicitis comes on suddenly and causes severe pain. The condition typically develops over the course of 24 to 48 hours. The pain gets worse when you move or take deep breaths.

Acute appendicitis often starts near the belly button and moves diagonally downward to the lower-right section of the abdomen. Some people say the pain of acute appendicitis is different from anything else they’ve ever felt. Other symptoms of acute appendicitis may include:

• Low-grade fever that worsens as the condition progresses

• Nausea and vomiting

• Loss of appetite

• Constipation or diarrhea

• Abdominal bloating and gas

Chronic appendicitis pain is far less specific than it is in acute appendicitis.

Related: Does Appendicitis Change Poop Color?

What Causes Chronic Appendicitis?

The cause of chronic appendicitis is not well understood. This is partly because the condition is so uncommon.

Researchers suspect the causes of chronic appendicitis may mirror the causes of acute appendicitis, which can include:

• Food or stool blocking the opening to the appendix

• Inflammation of the appendix due to infection or inflammatory bowel disease (IBD)

It's also possible that chronic appendicitis could have other causes such as:

• Appendix stones or other foreign objects

• Parasites

• Enlarged lymph nodes

• Injury to the abdomen

• Tumors
  

Diagnosis

Chronic appendicitis can be diagnosed through discussion with your healthcare provider, a physical exam, and imaging.

• Patient history: Your healthcare provider will ask about your symptoms, including any patterns you’ve noticed and when they occur. They will also ask about your overall health.

• Exam: The healthcare provider will feel your abdomen and possibly your right leg.

• Testing: A blood test will look for signs of infection, while a urine analysis will help rule out other conditions like bladder or kidney infections.

• Imaging: Chronic appendicitis may show up on a computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound. These can show whether the appendix is inflamed or blocked, which can indicate chronic appendicitis.
  

Misdiagnosis

Most healthcare providers know appendicitis as an acute condition. If someone doesn’t present with severe pain, they may not consider appendicitis as a possible diagnosis.

Since the symptoms of chronic appendicitis are milder, they can be confused with other conditions such as:

• Irritable bowel syndrome

• Urinary tract infection

• Kidney disease

• Other gastrointestinal conditions

This is especially true since chronic appendicitis is poorly understood and has no formal diagnostic criteria.

Related: Understanding Chronic Appendicitis

How is Chronic Appendicitis Treated?

If chronic appendicitis is diagnosed, a healthcare provider may choose to first give you antibiotics to treat an underlying infection that could be leading to inflammation of the appendix. Medication or not, they may also suggest that you monitor your symptoms before opting for surgery. They may also need to drain pus from the appendix.

Although these options may help you avoid an unnecessary procedure, research indicates that many people ultimately need to have their appendix removed. This is called an appendectomy.

Appendectomy

If you are experiencing severe or reoccurring pain, your healthcare provider may recommend an appendectomy, a surgery to remove the appendix.

This can be done via a traditional incision or laparoscopically, which uses three smaller incisions. The surgery usually lasts less than an hour and is often an outpatient procedure, meaning you will be sent home the same day.

Most people feel better immediately after surgery, but follow your healthcare provider's tips for recovery. Most people need to take it easy for about a week after the procedure.

Takeaway

Since chronic appendicitis is poorly understood, healthcare professionals aren’t sure what the best course of treatment is. Talk with your healthcare provider about what may be best for you.

Related: What Is the Recovery Time for Appendicitis Surgery?

Complications

Left untreated, chronic appendicitis can have an impact on quality of life. It can also lead to dangerous complications, including:

• Acute appendicitis

• Ruptured or burst appendix

• An abscess that develops around the appendix

• Inflammation of the abdominal lining

• Sepsis, a whole-body infection

If you have any symptoms of appendicitis, see a healthcare provider right away. Prompt treatment can prevent many of these complications.

Summary

People with chronic appendicitis typically feel milder pain than those with acute appendicitis. The pain may last for days at a time or it may come and go.

Like acute appendicitis, chronic appendicitis may progress to a ruptured appendix. This is why it is important to seek medical care if you have symptoms of chronic appendicitis.

Antibiotics are sometimes used to treat this condition, but many people with chronic appendicitis will ultimately need to undergo surgery to remove the appendix. 

Read the original article on Verywell Health.