Chronic appendicitis – the slow form of inflammatory process in a worm-shaped shoot of a blind gut most often connected with earlier postponed attack of an acute appendicitis. The clinical picture of chronic appendicitis is characterized by the discomfort, the aching pains in podvzdoshny area on the right amplifying at a physical tension; nausea, meteorizm, diarrhea or lock, mochepuzyrny, vaginal or rectal symptoms. Diagnosis of chronic appendicitis is based on an exception of other possible reasons of this symptomatology and can include studying of the anamnesis, carrying out a survey X-ray analysis, irrigoskopiya, kolonoskopiya, ultrasonography and other differential diagnostic testings of abdominal organs. Treatment of chronic appendicitis at not expressed manifestations – conservative, at a resistant pain syndrome the appendektomiya is shown.
Chronic appendicitis, unlike its sharp form, the disease which is rather seldom found in gastroenterology. At chronic appendicitis against the background of a slow inflammation atrophic and sclerous changes in an appendix, growths of granulyatsionny fabric, the hems and solderings leading to an obliteration of a gleam and deformation of a shoot, its union with the next bodies and surrounding fabrics can develop.
Reasons of chronic appendicitis
Distinguish three forms of chronic appendicitis: residual, recidivous and primary and chronic. The residual (residual) form of chronic appendicitis is characterized by existence in the anamnesis of a sick one bad attack which ended with recovery without surgery. At a chronic recidivous form repeated attacks of an acute appendicitis with the minimum clinical manifestations in a remission stage are noted. A number of authors allocates also primary and chronic (bespristupny) appendicitis developing gradually without the bad attack preceding it.
The residual (residual) form of chronic appendicitis is a consequence of earlier postponed attack of the acute appendicitis stopped without surgical removal of a shoot. Thus after subsiding of sharp manifestations in a blind gut conditions for maintenance of inflammatory process remain: solderings, cysts, appendix excesses, a giperplaziya of lymphoid fabric complicating its depletion.
Violation of blood circulation in the struck blind shoot promotes decrease in local immunity of a mucous membrane and activation of pathogenic microflora. The recurrence of appendicitis is possible, both for lack of its expeditious treatment, and after a subtotal appendektomiya when leaving a shoot from 2 cm long.
Symptoms of chronic appendicitis
The clinical picture of chronic appendicitis is characterized by prevalence of implicitly expressed, greased symptoms.
Chronic appendicitis is shown by feeling of discomfort and weight, the dull aching aches in the right podvzdoshny area, constant or arising incidentally, after physical activity and errors in a diet.
Patients with chronic appendicitis can complain of disorders of digestion: nausea, meteorizm, locks or diarrhea. Temperature at the same time more often remains normal, sometimes in the evenings rises to subfebrilny.
At chronic appendicitis also other symptoms can be observed: mochepuzyrny (a painful and frequent urination), vaginal (pain at a gynecologic research), rectal (pain at a rectal research). Repeated attacks of an acute inflammation of a blind shoot are shown by symptoms of an acute appendicitis.
Diagnosis of chronic appendicitis
Diagnosis of chronic appendicitis causes difficulties due to the lack of objective clinical symptoms of a disease. The easiest to diagnose chronic recurrent appendicitis, at the same time data of the anamnesis (existence of several bad attacks) are very important. During the next bad attack the diagnosis of an acute appendicitis, but not an aggravation of chronic is made.
Can be indirect symptoms of chronic appendicitis at a palpation of a stomach local morbidity in the right podvzdoshny area, quite often positive symptom of Obraztsov, sometimes – positive symptoms of Rovzinga, Sitkovsky.
For diagnosis of chronic appendicitis surely carry out the X-ray contrast irrigoskopiya of a large intestine allowing to reveal absence or partial filling with barium of a blind shoot and delay of its depletion that demonstrates change of a form of an appendix, deformation, narrowing of its gleam. Carrying out a kolonoskopiya helps to reject existence of new growths in a blind and thick gut, and a survey X-ray analysis and ultrasonography – in an abdominal cavity. Clinical blood tests also wet the patient at chronic appendicitis, as a rule, without the expressed changes.
At primary and chronic appendicitis the diagnosis is made by process of elimination other possible diseases of the abdominal organs giving similar symptomatology. It is necessary to carry out differential diagnosis of chronic appendicitis with stomach ulcer, a disease Krone, a syndrome of the angry intestines, chronic cholecystitis, spastic colitis, a belly toad, iyersiniozy, tiflity and ileotiflity other etiology (for example, tubercular, malignant), diseases of kidneys and uric ways, gynecologic diseases, a helminthic invasion at children, etc.
Treatment of chronic appendicitis
At the established diagnosis of chronic appendicitis and a resistant pain syndrome surgical treatment is shown: removal of a blind shoot – an appendektomiya in the open way or in a laparoscopic way. During operation also carry out audit of abdominal organs for identification of other possible reasons of pains in the right podvzdoshny area.
In the postoperative period antibiotic treatment is surely carried out. The remote results after expeditious treatment of chronic appendicitis it is slightly worse, than after an acute appendicitis as development of adhesive process is more often noted.
If at the patient with chronic appendicitis not expressed symptomatology is noted, apply conservative treatment – reception of spazmolitichesky medicines, physiotherapeutic procedures, elimination of disorders of intestines.
Macroscopic changes in an appendix at chronic appendicitis can be so not expressed that it is possible to reveal them only at a morphological research of a remote shoot. If the blind shoot was not changed, there is a probability that surgical intervention can aggravate even more available pain syndrome which formed the basis for an appendektomiya.