Symptoms of chronic inflammation of the appendix. What is chronic appendicitis and how to treat it? Can appendicitis be chronic?

Exist various shapes chronic appendicitis, but each is characterized by the fact that the course of the pathology is sluggish. The inflammatory process is usually a consequence of acute appendicitis, if the appropriate conditions for the development of the disease have developed. Symptoms are usually vague. The patient is shown conservative treatment, but sometimes it is necessary surgical intervention.

General information

Chronic appendicitis is a chronic inflammatory process that develops in the appendix, which extends from the cecum. The disease is diagnosed infrequently compared to the acute form of the disease. Clinical picture characterized by mild symptoms. Patients complain of discomfort, slight pain, nausea, etc. It is impossible to determine from the symptoms that the disease is appendicitis. Making an accurate diagnosis requires the use instrumental methods research and differential analysis. Since the pathology is not characterized clear signs, therapy is predominantly medicinal, but in case of severe pain, surgery is indicated for the patient. Neglect of the disease can cause a lot of complications.

Who is susceptible to the disease?

Any appendicitis is more common in women than in children or adult men. In this case, the criteria of race, health, and age are completely irrelevant. Doctors explain this predisposition by physiological structure female body. Appendicitis is an inflammation of the appendix, which often occurs due to pathological inflammatory processes of other organs that are localized in the peritoneum. Since a woman has abdominal cavity Since women have more organs than men, the risk of developing appendicitis as a secondary disease is much higher.

Classification

The disease is classified taking into account the criteria for organ localization, which helps to immediately make an accurate diagnosis. Appendicitis can develop in acute and chronic forms. The latter, in turn, is divided into the following types:

recurrent (exacerbations occur periodically);
residual chronic appendix (residual chronic appendicitis that remains after acute stage inflammatory process);
primary-chronic (the pathology immediately develops as primary).

Causes of chronic appendicitis

Appendicitis is usually caused by a blockage of the appendix feces or hit foreign bodies.

The chronic form of the pathology develops after incomplete treatment acute illness when sufficient excision of the appendix has not been carried out, causing the disease to periodically worsen. It is not always possible to determine the cause of the problem. The causes of chronic pathology include the following:

hereditary predisposition;
dysfunction defense mechanisms immune system;
problems in the functioning of the endocrine system;
diseases of the digestive system;
disturbances in the blood supply system.

The immediate provocateurs are:

chronic constipation;
excessive body weight;
hypothermia;
smoking, alcohol, etc.;
physically hard work;
overwork, etc.

Symptoms

Symptoms of chronic appendicitis are mild and often blurred:

painful sensations in the navel area, which can bother you constantly or periodically, for example, when playing sports, coughing, etc.;
the general condition of the patient is practically unchanged, performance does not deteriorate;
diarrhea gives way to constipation;
temperature indicators do not change;
discomfort appears in the lower right part of the abdominal cavity;
nausea;
gagging;
increased urination;
pain in the rectal area;
painful sensations during sexual intercourse.

When an exacerbation occurs, the following symptoms occur:

severe pain in the abdomen;
nausea;
dryness of the oral mucosa;
raid white on the tongue;
high temperature, etc.

Among women

Pathology is more often diagnosed in women than in children or adult men, which is determined by physiology. The structure and localization of the abdominal organs explains the difference in the signs of the disease in women:

cramping pain in the lower back;
discomfort and feeling of heaviness in the area of the ovaries and vagina, especially during sexual intercourse or during menstruation;
loss of appetite;
dyspeptic disorders;
pain in the right hypochondrium (rare);
the pain gets worse after junk food or physical activity;
frequent trips to the toilet, etc.

In men

In an adult male, an attack is primarily manifested by dull nagging pain on the right side of the abdomen. Painful sensations are felt more when moving, coughing, etc. Sometimes pain occurs in the right hypochondrium. Dyspeptic syndrome during exacerbation in men is more pronounced than in women. If the patient lies on his right side, the condition may improve, which is a reason to immediately seek help. medical care.

Carrying out diagnostics

Only after a thorough diagnosis will a specialist make the correct diagnosis.

A doctor can determine the cause of the disease and make a diagnosis only after conducting a thorough diagnosis. The specialist collects information about signs of the disease, complaints, performs palpation and prescribes the necessary tests:

ultrasonography;
general blood and urine analysis;
computed tomography;
irrigoscopy;
colonoscopy;
diagnostic laparoscopy, etc.

In addition, it is necessary to carry out differential diagnosis with:

cystitis;
vaginitis;
peptic ulcer, etc.

Treatment

After making a diagnosis, the doctor determines the necessary treatment methods. Treatment of chronic appendicitis can be carried out classically conservative method or through surgery (for severe pain). In addition, the patient is prescribed dietary nutrition. Self-medication is extremely dangerous, since the inflammatory process in the appendix can lead to dangerous complications.

Taking medications

Attacks of appendicitis can be treated with medication. The patient is prescribed:

antibiotics;
anti-inflammatory drugs;
antispasmodics;
vitamin and mineral complexes;
immunocorrectors;
medications to improve blood flow;
beneficial bacteria, etc.

Only after consulting a doctor can you take traditional healing infusions.

Take medications on your own traditional medicine not recommended even in case of illness, which is not clearly characterized pronounced signs. Before taking them, you should consult your doctor. Healers recommend using components that have a beneficial effect on the functioning of the immune system and intestines:

caraway seeds with milk (5 g per 100 ml, drink the decoction an hour after preparation for 7 days);
blackberry (tea);
tarragon (5 g per 200 ml, boil and drink 3 times a day, ¼ cup for 4 days), etc.

Nutrition correction

Diet will not help get rid of chronic appendicitis, but as a prevention and aid quite effective. The diet consists of adhering to several rules:

establish a food intake regime;
avoidance of foods that are difficult to digest and poorly absorbed;
increasing the amount of fiber in the menu (fruits, vegetables, bran, etc.).

Surgical intervention

If medications do not help or if severe painful sensations, surgical treatment is necessary. The operation usually involves removing the appendix, especially if adhesions and scars have appeared on the organ. Surgical treatment can be carried out endoscopically or with open cavity intervention. Types of appendectomy:

typical;
retrograde;
laparoscopic;
transluminal.

After surgery, the patient must take a course of antibiotics.

After the operation, the patient must take an antibiotic, a pain reliever, etc. In addition, immediately after the operation, the patient is advised to fast and go to bed. The patient must adhere to a diet. Full recovery depends on the type of surgery. Physical activity is contraindicated for approximately 60 days, after which you can begin gentle sports, such as swimming.

May develop after exposure to acute form due to partial obstruction of the lumen. It is a consequence of changes that developed during exacerbations and were expressed by scars, kinks, adhesions and ulcerations of the mucous membrane.

In children, the cause of chronic appendicitis could be hardened feces that block the exit of the appendix (coprolitus disease). This deviation is detected using an x-ray of the abdominal cavity.

The primary chronic form is judged by the absence of an initial acute attack. The disease is not common and occurs in only 1% of patients who contact specialists with signs of appendicitis.

Features of the course of chronic appendicitis

For proper treatment, the disease must be differentiated from pathologies. gastrointestinal tract and abdominal cavity. The symptoms of chronic appendicitis often coincide with the picture of cholecystitis, peptic ulcer, pyelite, inflammatory diseases female appendages.

Patients complain of frequent attacks of pain in the right side. The danger of this condition is that at any moment a painful attack can transform into peritonitis.

In order not to miss the moment and contact the clinic in a timely manner, the patient should pay attention to such signs of the disease as:
- nausea;
- vomit;
- severe pain during defecation, the products of which are liquid.

But the main sign chronic course Appendicitis is a dull pain that periodically bothers the patient when walking and exercising. The body temperature remains normal.

Thanks to laparoscopy, the doctor is able to assess the condition of the appendix and neighboring organs. This procedure is both diagnostic and therapeutic. If an appendix is found, it is immediately removed.

What is the treatment for chronic appendicitis?

The manifestations of chronic appendicitis can only be eliminated surgically. During the operation, the appendix is removed in the same way as in the acute form. Complications such as thrombophlebitis, wound suppuration, peritonitis and pneumonia are very rare.

The risk of the disease ending in death is so small that it is only 0.05% of the total number of operations performed. Almost all cases of treatment of chronic appendicitis ended full recovery patients.

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

In this form, after suffering an acute attack of appendicitis, the pain subsides. After some time, a new attack is observed - relapse of appendicitis. Consequently, this form is characterized by repeated attacks acute inflammation process. In the intervals between attacks, patients experience constant pain in the area of the cecum.

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

Classification

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

The development of the 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.
The recurrent form of the disease is characterized by periods of exacerbation and remission.
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 did not receive appropriate medical care during the acute course of the disease. In this case, scars and adhesions appear in the tissues of the appendix, the lumen narrows, which is why 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 vague picture of symptoms in both women and men. The main symptom of the disease is a regularly occurring, aching, mild pain in the right side, at the location of the appendix.

Also signs of chronic appendicitis include:

heaviness, flatulence, presence discomfort in a stomach;
mild nausea;
indigestion;
lack of appetite;
frequent bowel movements - diarrhea or constipation;
chronic low-grade fever bodies.

Pain may increase with heavy exertion (due to increased pressure inside the peritoneum), during bowel movements, or when coughing. Changes in the functioning of the gastrointestinal tract are observed - constipation and diarrhea. In case of exacerbation, vomiting and nausea occur.

It is very important to diagnose and begin to treat chronic appendicitis as early as possible, since the constant presence of a source of infection in the body certainly does not have the most favorable effect on its functioning. Moreover, this is fraught with perforation of the appendix with subsequent development of peritonitis, which can cause the death of the patient.

Chronic appendicitis - symptoms in women

Initially, signs of appendicitis in women manifest themselves as pain in the gastrointestinal tract. The pain spreads to the right lower abdomen and intensifies during a gynecological examination.

During periods of hormonal changes (for example, during pregnancy or menstruation), the pain is pronounced and localized in the ovaries and vagina. Against the background of appendicitis, disruptions occur in the cycle. During lovemaking, as well as after it, spasms occur, severe pain in the vaginal area.

Diagnosis and treatment

Since chronic appendicitis manifests itself general symptoms, characteristic of a number of other diseases internal organs, to make an accurate diagnosis, a complex of laboratory and instrumental diagnostic methods is used.

Diagnostic measures to identify chronic appendicitis:

Pain in the right iliac region, increased pain when lying on the left side, when bending right leg – these signs raise 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, the pain spreads to the entire abdomen.
Clinical tests blood and urine. Not sufficient to make a diagnosis, but still important related methods, allowing to confirm or exclude the disease.
X-ray with contrast agent. This study helps to identify obstruction of the opening connecting the appendix to the cecum. Also, radiography can show fibrous adhesions and accumulations of feces.
Ultrasound diagnostics. Simple and safe method research to quickly confirm the diagnosis. During the study, not only the condition of the appendix, but also other abdominal organs is assessed.
CT scan. With the help of this study, it is possible to exclude diseases that have similar symptoms.
Laparoscopy. Surgical diagnostic method, consisting in the introduction 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 remove the appendix if an inflammatory process is detected.

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

Kidney diseases;
Gynecological diseases.

The treatment for chronic appendicitis is the same as for the acute form of the disease - surgical removal of the inflamed appendix. Appendectomy can be performed either laparoscopically or open method– 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 mild symptoms, conservative treatment is used - taking antispasmodics, physiotherapeutic procedures, eliminating intestinal disorders.

Postoperative period

For two days after the appendix was removed, the patient was prescribed bed rest. Assign antibacterial therapy for the prevention of surgical infections. During this period it is very important nursing care to prevent possible complications.

The suture is removed 10-12 days after surgery. Before this, sudden movements and muscle tension should be avoided. abdominal wall to avoid cutting through the seam. Recovery muscle tissue takes several months. A small pale scar remains on the skin, as can be seen in the photo.

The period when you can return to your normal lifestyle depends on the type of appendectomy and the nature 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 heavy lifting is allowed only after 3–6 months. Avoid visiting a bathhouse or sauna for at least 3-4 weeks.

Diet

At conservative therapy and during rehabilitation period After surgery, a special diet must be followed:

Avoid spices, smoked meats, canned food, and sweet carbonated drinks.
It is recommended to exclude strong black tea and coffee. Worth consuming green tea, fruit drinks and compotes.
You need to adhere to a fractional diet - 5-6 times a day in small portions.
Spicy, salty, fatty, fried foods should be excluded.

As for folk remedies, avoid visiting a doctor or be inattentive to the “signals” of your own body in the form of attacks of pain, hoping for folk remedies, is strictly prohibited! Herbal medicine and home recipes are useful as additional measures to strengthen the body and improve intestinal function, as well as in the fight against pathogenic microorganisms.

Disease prevention

Special preventive measures does not exist. It is recommended to keep healthy image life, eat rationally, avoid stressful conditions, give up bad habits, lose weight.

Let's talk about the symptoms of chronic appendicitis in women and men. This pathology can happen to anyone, so the main thing is to know the root causes of the disease. Let's look at the main signs, symptoms and treatment of appendicitis.

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The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any medications have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

Chronic appendicitis and its symptoms in women

Symptoms of appendicitis are associated with pain in the right side of the abdomen. The pain has different character: aching, pulling, paroxysmal.

The paroxysmal state may take some time. Any movement of the patient is difficult, the patient cannot lie quietly on one of the sides.

In addition to pain, there are many other symptoms that are subsequently diagnosed as attacks of appendicitis:

Lack of stool or diarrhea;
Vomiting and periodic nausea;
Pain during examination by an obstetrician-gynecologist;
Temperature changes to a maximum at night;
When palpating the patient in a supine position with the right limb raised, the compaction and appendix are palpated.

These attacks are in many ways similar to diseases that are associated with the gastrointestinal tract. Before diagnosing, the doctor checks the symptoms of diseases, which include cholecystitis, urolithiasis disease, gynecological diseases, ulcerative attacks.

Possible causes of the disease

Chronic appendicitis refers to the processes inflammatory in nature, all signs of which are sluggish and appear in the area of the cecum, located in the right lower part of the abdomen. Similar phenomena are observed against the background of early appendicitis.

The development of the disease depends on the following reasons:

Spread of infection from the appendix to the peritoneum, defensive reactions the body provokes the occurrence of an inflammatory process in the body;
Blockage of the colon with feces, intoxication begins;
Blockage of the arteries supplying the appendix;
Gynecological diseases that are associated with uterine pathology;
Long-term abuse of unhealthy and fast food;
Hereditary factors;
Problems with the release of contents from the appendix.

Depending on the root cause, the disease is:

Residual - pain after acute appendicitis;
Recurrent - signs of this form appear quickly and acutely: an increase in body temperature, unbearable pain;
Quiet course - difficult to diagnose, since it is asymptomatic, no attacks in the form of cramping pain are observed.

Clinical signs in men

The first symptoms of chronic appendicitis in men appear within 7 hours from the onset of the first attack.

The clinical picture of male appendicitis is as follows:

Constant nausea accompanied by pain;
Dry mouth and presence white plaque on the tongue;
Increased body temperature;
Pain in the lower right side, often near the testicle.

According to statistics, teenagers and young men of 20 years old suffer from appendicitis. Perforation of the appendix is much more common in men than in women.

Diagnosis of the chronic form

The main role in treatment is played by diagnosis, which can be carried out using the following methods:

Ultrasound of the abdominal organs - allows you to determine the presence of an inflammatory process or abscess of the appendix.
Irrigoscopy is an X-ray examination of the colon; a contrast agent (barium sulfate) is injected into the body, which reveals changes in the intestines, the presence of stones and stenosis in the appendix.
Carrying out laboratory tests(blood, urine) helps establish inflammatory processes in the body.
Colonoscopy is a procedure that helps rule out colon tumors.

If there is a history of acute appendicitis, diagnosing chronic appendicitis is simplified many times. Diagnosis can be made by palpation. With chronic appendicitis, the skin on the right side of the groin appears flabby.

Particular difficulties in diagnosing the disease arise in pregnant women. Only an experienced surgeon can diagnose diseases and identify negative changes in the abdomen.

A simple test is enough. If the patient has difficulty bending over right side or when bending over, he experiences burning pain, which forces him to hold his right side with his hand - this no longer excludes appendicitis.

The second method of determining appendicitis when examining a patient is coughing. The doctor asks the patient to cough well while lying down, and then turn on his right side and laugh. The patient's grimace will indicate the presence of the disease.

Self-diagnosis chronic inflammation appendix is excluded, since there are many diseases that are similar in symptoms to appendicitis. Delaying seeking help from specialists can cost the patient his life.

Differential diagnosis of the disease

Appendicitis belongs to the group of diseases that can masquerade as other diseases.

Before deciding on surgical intervention, conduct a detailed examination of the patient and conduct laboratory tests.

Symptoms of appendicitis may also indicate the presence of diseases in the patient’s body:

Urolithiasis;
Stomach ulcer;
Crohn's disease;
Ovarian neoplasms;
Intestinal obstruction;
False pregnancy;
Endometritis.

There are many diseases with similar symptoms. Before cutting the abdomen, you must make sure that the disease is associated with appendicitis and not with the pathology of other organs.

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Features of nutrition in pathology

After surgery, following a certain diet, since ignoring it leads to unbearable pain, disruption of the entire gastrointestinal tract. The recovery process and the absence of complications after surgery depend on how accurately the diet is followed.

Appendicitis involves surgery, the duration of which lasts from half an hour or more. It all depends on the severity and duration of the disease.

The operation takes little time, after it is carried out it is necessary to comply strict diet, which is directed:

To restore tissue in damaged areas of the intestine;
Minimizing the load on the digestive system;
Restoring the functioning of the gastrointestinal tract.

Dietary food after removal of the appendix requires the daily slow entry into the digestive tract of a small amount of food with a liquid consistency. The essence of the diet after removal of the appendix comes down to fortifying the patient’s body.

In the first 12 hours after the operation, the patient is prohibited from eating any food. All that is possible is to wet the patient’s lips with distilled water to prevent them from drying out.

The approach is related to the prevention of infection of the digestive tract through food. After surgical intervention all tissues are fragile and not completely healed.

What is the duration dietary nutrition depends on the personal characteristics of the body and the speed of the healing process. Recovery monitoring is carried out by a doctor, who makes a conclusion about the diversity of the patient’s diet.

What are the principles of nutrition after surgery?

The patient is required to start eating small portions;
Swallowing whole is unacceptable, each piece takes a long time to chew;
Initial nutrition should be predominantly “hungry”;
The consistency and quantitative composition of the food consumed must correspond to the daily recommendations of the attending physician;
How the diet will change depends on the patient himself.

After surgery to remove the appendix, all food should be consumed in pureed form.

No fatty, salty, sour foods.

Only boiled and proper food. A feature of the diet after appendicitis is the daily consumption of a significant amount of food. Water-alkaline balance is important in the process of rapid recovery of the patient.

If you follow the correct diet, the healing process will make itself felt 2 weeks after the operation.

Prohibited products for the patient

Salt and any products with a high amount of salt in it;
Smoked products of any kind: fish, meat;
Spicy and fatty foods;
Flour products and cream products that slow down the absorption of food;
Carbonated drinks that contribute to the formation of flatulence in the body;
Dairy products with a high fat content and lactic acid bacteria can provoke fermentation processes and bloating.

Authorized Products

Zucchini and pumpkin;
Chicken broth;
Yoghurts;
Lean varieties of meat and fish in finely processed form;
Vegetable soups;
Teas, jelly, compotes.

All of these dishes should be eaten warm. Excessive consumption of them helps to deteriorate the digestion of food and the formation of gas formation.

Treatment of chronic appendicitis

The use of any physiotherapeutic procedures until a complete diagnosis is established is prohibited.
It is prohibited to accept any medicines, painkillers.
Treatment of appendicitis begins with intravenous medications.
Further treatment methods depend entirely on the form of the disease.
At the first stage, if you seek medical help in a timely manner, the risk of perforation of the appendix is not so great. For such patients, conservative treatment with antibiotics is recommended to minimize inflammation. Patients with this diagnosis do not require immediate surgical intervention. Preparation for an appendectomy is carried out gradually.
If the attacks last for a week, the patient, in addition to treatment with antibiotics, is prescribed a procedure for draining the abdominal abscess.
Without surgical treatment removal of appendicitis is impossible. And the sooner the patient seeks advice from a doctor, the more favorable the prognosis will be.

Removal of the appendix is carried out by appendectomy, a laparoscopy method, the result of which is several holes in the anterior abdominal wall.

Transluminal surgery involves the insertion through the genitals of instruments that visually assess the patient’s condition, which subsequently makes it possible to determine the method of performing the operation.

If the examination reveals that appendicitis has become perforated, treatment with antibiotics until it disappears completely clinical signs appendicitis.

Help from folk remedies

The vermiform appendix is an organ that does not play a significant role in the performance of the body. But in the case of inflammatory processes, its presence threatens trouble for the patient.

When appendicitis occurs, the initial pain begins in the lower part of the right side, and is subsequently supplemented by constipation or diarrhea.

Apply traditional methods should be done after consultation with your doctor.

Fenugreek decoction.

A teaspoon of seeds brewed with a glass of boiling water for an hour is excellent remedy for quick removal of mucus from the body. The decoction is consumed in small portions throughout the day.

Wheat.

Significant consumption of wheat grains eliminates constipation and improves the functioning of the gastrointestinal tract. There is no danger for patients with wheat grains intestinal disorders and stomach problems. The method is used in the role preventive measures from appendicitis.

Ginger+garlic.

They have an anti-inflammatory effect, which has a positive effect in the treatment of appendicitis. The products can be consumed both together and separately. The composition strengthens the immune system.

Possible consequences and complications

The most serious complication after chronic appendicitis is peritonitis, which can be diffuse or not.

In the diffuse form, inflammatory processes are observed in the peritoneum, which is often a cause of death.

– a sluggish form of the inflammatory process in the vermiform appendix of the cecum, most often associated with a previous attack of acute appendicitis. The clinical picture of chronic appendicitis is characterized by discomfort, aching pain in the iliac region on the right, aggravated by physical stress; nausea, flatulence, diarrhea or constipation, bladder, vaginal or rectal symptoms. Diagnosis of chronic appendicitis is based on the exclusion of other possible reasons of this symptomatology and may include studying the anamnesis, conducting plain radiography, irrigoscopy, colonoscopy, ultrasound and other differential diagnostic studies of the abdominal organs. Treatment of chronic appendicitis with mild manifestations is conservative; in case of persistent pain, appendectomy is indicated.

General information

Chronic appendicitis, in contrast to its acute form, is a rather rare disease in gastroenterology. In chronic appendicitis, against the background of sluggish inflammation, atrophic and sclerotic changes in the appendix, proliferation of granulation tissue, scars and adhesions can develop, leading to obliteration of the lumen and deformation of the appendix, its fusion with neighboring organs and surrounding tissues.

Causes

There are three forms of chronic appendicitis: residual, recurrent and primary chronic. The residual (residual) form of chronic appendicitis is characterized by the patient’s history of one acute attack, which ended in recovery without surgery. In the chronic relapsing form, repeated attacks of acute appendicitis are observed with minimal clinical manifestations in remission. A number of authors also distinguish primary chronic (attackless) appendicitis, which develops gradually, without a preceding acute attack.

The residual (residual) form of chronic appendicitis is a consequence of a previously suffered attack of acute appendicitis, which was stopped without surgical removal process. Moreover, after subsiding acute manifestations in the cecum, conditions remain to maintain the inflammatory process: adhesions, cysts, kinks of the appendix, hyperplasia of lymphoid tissue, making it difficult to empty it.

Impaired blood circulation in the affected caecum contributes to a decrease in local immunity of the mucous membrane and activation of pathogenic microflora. Recurrence of appendicitis is possible, as in its absence surgical treatment, and after subtotal appendectomy when leaving an appendage of 2 cm in length.

Symptoms of chronic appendicitis

The clinical picture of chronic appendicitis is characterized by a predominance of vague, vague symptoms. Chronic appendicitis is manifested by a feeling of discomfort and heaviness, dull aching pain in the right iliac region, constant or occurring occasionally, after physical activity and errors in diet. Patients with chronic appendicitis may complain of digestive disorders: nausea, flatulence, constipation or diarrhea. The temperature often remains normal, sometimes in the evenings it rises to low-grade fever.

With chronic appendicitis, other symptoms may be observed: bladder (painful and frequent urination), vaginal (pain during gynecological examination), rectal ( painful sensations during rectal examination). Repeated attacks of acute inflammation of the cecum manifest themselves as symptoms of acute appendicitis.

Diagnostics

Diagnosis of chronic appendicitis is difficult due to the lack of objective clinical symptoms diseases. The easiest way to diagnose chronic recurrent appendicitis is that anamnesis data (presence of several acute attacks) is very important. During the next acute attack, a diagnosis of acute appendicitis is made, and not an exacerbation of chronic appendicitis.

Indirect signs of chronic appendicitis on palpation of the abdomen may be local pain in the right iliac region, often a positive Obraztsov’s sign, and sometimes positive Rovzing’s and Sitkovsky’s symptoms.

To diagnose chronic appendicitis, it is necessary to perform X-ray contrast irrigoscopy of the large intestine, which reveals the absence or partial filling of the cecum with barium and the slowdown of its emptying, which indicates a change in the shape of the appendix, deformation, and narrowing of its lumen. Conducting a colonoscopy helps to exclude the presence of tumors in the cecum and colon, and plain radiography and ultrasound - in the abdominal cavity. Clinical tests of blood and urine of a patient with chronic appendicitis, as a rule, are without pronounced changes.

In primary chronic appendicitis, the diagnosis is made by excluding others. possible diseases abdominal organs, giving similar symptoms. It is necessary to carry out differential diagnosis chronic appendicitis with stomach ulcers, Crohn's disease, irritable bowel syndrome,

IN postoperative period Antibiotic therapy is mandatory. Long-term results after surgical treatment of chronic appendicitis are somewhat worse than after acute appendicitis, since the development of adhesions is more often noted.

If a patient with chronic appendicitis has mild symptoms, conservative treatment is used - taking antispasmodics, physiotherapeutic procedures, eliminating intestinal disorders.

Macroscopic changes in the appendix during chronic appendicitis can be so subtle that they can only be detected with morphological study removed process. If the caecum appears unchanged, there is a possibility that surgery may further aggravate the existing pain syndrome, which served as the basis for appendectomy.