Is the appendix pain constant
Is It Chronic Appendicitis?
HERSHEY. The 28-year-old presented with increasing abdominal pain in the right lower quadrant for three days.
The symptoms began with a sharp pain in the right abdomen that radiated into the back.
The woman did not remember any triggering event and denied symptoms such as fever, nausea, vomiting, difficulty urinating, blood in the urine and vaginal discharge.
Further questioning revealed that the patient had already gone through six similar episodes of abdominal pain in the past two years.
Several medical examinations had remained inconclusive; only once had antibiotics been given on suspicion of a urinary tract infection. In all cases, the pain disappeared after three to four days (The American Journal of Medicine 2012, online November 21).
At the current presentation, the patient was free of fever, the abdomen was soft with no peritoneal signs and no palpable mass, there was only a slight tenderness in the right lower quadrant.
The laboratory showed a greatly increased white blood cell count (61,000 / microliter) and an accelerated blood sedimentation (30 mm / h). A transvaginal ultrasound was normal.
Include appendicitis in the differential diagnosis
Because of the recurrence of symptoms, a contrast-enhanced computed tomogram was performed. An enlarged appendix was found with no evidence of an abscess or fluid accumulation.
The subsequent laparoscopic appendectomy revealed a fibrotic and enlarged appendix with adhesions - and thus confirmed the suspicion of chronic inflammation. The patient was permanently symptom-free after the operation.
"This case report is intended to remind doctors that appendicitis can spontaneously disappear and reappear," write the authors led by Dr. Shenil Shah of Milton S. Hershey Medical Center in Pennsylvania.
Appendicitis must be included in the differential diagnostic considerations if patients are repeatedly afflicted with abdominal pain in the lower right quadrant.
Shah et al. estimate that around 1.5 percent of all appendicides take a chronic course. A partial and temporary relocation of the appendix, for example due to fecal stones, is assumed to be the cause.
Because the symptoms are mostly atypical, they are often misinterpreted, especially in sexually active women. If there is strong clinical suspicion, Shah et al. the clarification by CT and, in the case of confirmation, the prompt op.
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