Chronic appendicitis is defined by inflammation of the appendix over time with symptoms lasting for more than three weeks duration 1. The condition should be differentiated from recurrent appendicitis, in which one or more episodes of flares of symptoms last 24 to 48 hours and subside on their own. Chronic appendicitis is a controversial entity in diagnosis and management for most clinicians.
Chronic appendicitis is thought to be a rare cause of appendicitis. Because the existence of the entity itself is controversial, the true prevalence is unknown. Some authors propose that some small percentage of acute appendicitis cases are an acute presentation of chronic appendicitis 2,3.
Chronic appendicitis can be difficult to differentiate clinically from acute appendicitis. Even though the history is longer and less severe in the former, the presentation can be either as an acute severe episode mimicking the latter or atypical symptoms making the diagnosis more difficult 4.
Even though not considered a surgical emergency, the condition can have disastrous complications such as perforation and abscess formation 4.
The condition can be due to partial but persistent obstruction of the appendiceal lumen or chronic inflammatory conditions such as granulomatous appendicitis 4.
Radiological findings are similar to those of acute appendicitis and essentially radiologically indistinguishable 5.
- 1. Jaime L. Checkoff, Richard J. Wechsler, Levon N. Nazarian. Chronic Inflammatory Appendiceal Conditions That Mimic Acute Appendicitis on Helical CT. (2012) American Journal of Roentgenology. doi:10.2214/ajr.179.3.1790731
- 2. Jiten P. Kothadia, Seymour Katz, Lev Ginzburg. Chronic appendicitis: uncommon cause of chronic abdominal pain:. (2015) Therapeutic Advances in Gastroenterology. doi:10.1177/1756283X15576438
- 3. Shah SS, Gaffney RR, Dykes TM, Goldstein JP. Chronic appendicitis: an often forgotten cause of recurrent abdominal pain. Am J Med. 2013 Jan;126(1):e7-8. doi: 10.1016/j.amjmed.2012.05.032. Epub 2012 Nov 20. PMID: 23177545. doi:10.1016/j.amjmed.2012.05.032
- 4. Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. (2015) Therapeutic advances in gastroenterology. 8 (3): 160-2. doi:10.1177/1756283X15576438 - Pubmed
- 5. Rao P, Rao RJ, Rao NR, Rao MC, Rao. The computed tomography appearance of recurrent and chronic appendicitis. (1998) The American journal of emergency medicine. doi:10.1016/s0735-6757(98)90060-2 - Pubmed