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

Exists various forms chronic appendicitis, but each is characterized by the fact that the course of the pathology is sluggish. The inflammatory process is usually the result of acute appendicitis, if there are appropriate conditions for the development of the disease. Symptoms are usually blurred. The patient is shown conservative treatment, but sometimes it is necessary surgical intervention.

General information

Chronic appendicitis is an inflammatory process of a chronic nature that develops in the appendix, which extends from the caecum. The disease is diagnosed infrequently in comparison with 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. An accurate diagnosis requires the use of instrumental methods research and differential analysis. Since the pathology is not characterized bright signs, therapy is predominantly medical, but with severe pain, the patient is shown surgery. The neglect of the disease can cause a lot of complications.

Who is susceptible to illness?

Any type of appendicitis is more common in women than in children or adult men. At the same time, the criteria of race, health, age do not matter at all. Doctors explain this predisposition by a physiological device. female body. Appendicitis is an inflammation of the appendix, which often occurs due to pathological inflammatory processes in other organs that are localized in the peritoneum. Since the woman in abdominal cavity more organs are placed than in men, the risk of developing appendicitis, as a secondary disease, is much higher.

Classification

The disease is classified, taking into account the criteria for the localization of the organ, 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 (periodically there are exacerbations);
residual chronic appendix (residual chronic appendicitis that remains after acute stage inflammatory process);
primary chronic (pathology immediately develops as primary).

Causes of chronic appendicitis

Appendicitis is usually caused by a blocked appendix. stool or hit foreign bodies.

The chronic form of the pathology develops after undertreated acute illness when sufficient excision of the appendix has not been carried out, which is why the disease periodically worsens. 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 work of the endocrine system;
diseases of the digestive system;
disorders in the circulatory 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, often blurred:

pain in the navel area, which can disturb constantly or for periods, for example, when playing sports, coughing, etc.;
the general condition of the patient is almost unchanged, performance does not deteriorate;
diarrhea is replaced by 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;
pain during intercourse.

When an exacerbation occurs, the following symptoms occur:

severe pain in the abdomen;
nausea;
dryness of the mucous membranes of the oral cavity;
plaque white color in the language;
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 a feeling of heaviness in the area of the ovaries and vagina, especially during intercourse or during menstruation;
loss of appetite;
dyspeptic disorders;
pain in the right hypochondrium (rare);
pain gets worse after junk food or physical activity;
frequent trips to the toilet, etc.

In men

In an adult man, an attack, first of all, is manifested by dull pulling pains in the right side of the abdomen. Painful sensations are more felt during movements, coughing, etc. Sometimes there are pains 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 medical advice. medical care.

Carrying out diagnostics

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

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

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

In addition, it is necessary to conduct a differential diagnosis with:

cystitis;
vaginitis;
peptic ulcer, etc.

Treatment

After making a diagnosis, the doctor determines the necessary methods of therapy. Treatment of chronic appendicitis can be carried out by the classical conservative method or through surgery (for severe pain). In addition, the patient is shown 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 stopped with medication. The patient is prescribed:

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

Only after consulting with a doctor, you can take folk healing infusions.

Take medication on your own traditional medicine not recommended even for illness that is not clearly characterized pronounced signs. You should consult your doctor before taking them. Healers recommend using components that favorably affect the functioning of the immune system and intestines:

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

Power correction

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

adjust the mode of eating;
refusal of products that are hard to digest and poorly absorbed;
increasing the amount of fiber in the menu (fruits, vegetables, bran, etc.).

Surgical intervention

If the medicines did not help or with strong painful sensations required surgical treatment. The operation usually consists in removing the appendix, especially if adhesions and scars have appeared on the organ. Surgical treatment can be carried out by endoscopic method or with open abdominal intervention. Types of appendectomy:

typical;
retrograde;
laparoscopic;
transluminal.

After surgery, the patient needs to drink a course of antibiotics.

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

May develop after suffering from an acute form due to partial obstruction of the lumen. It is a consequence of the changes that were developed during the period of 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 blocked the exit from the appendix (coprolit disease). This deviation is revealed with the help of 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 only in 1% of patients who turn to specialists with signs of appendicitis.

Features of the course of chronic appendicitis

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

Patients complain of frequent bouts of pain in the right side. The danger of this condition lies in the fact that at any time a pain 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 cramps during defecation, the products of which are liquid.

But the main symptom chronic course appendicitis is a dull pain that periodically bothers the patient when walking and physical exertion. The body temperature value remains normal.

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

What is the treatment for chronic appendicitis?

It is possible to eliminate the manifestations of chronic appendicitis only surgically. During the operation, the appendix is removed in the same way as in the acute form. Complications in the form of thrombophlebitis, suppuration of wounds, peritonitis and pneumonia are very rare.

The proportion of the risk of ending the disease with a fatal outcome 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 in complete recovery of patients.

A previous attack of acute appendicitis in women or men in some cases can turn 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 should distinguish between chronic recurrent appendicitis.

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

Due to prolonged inflammation in the appendix, sclerotic changes are observed, it is also possible to gradually ulcerate, deform, the appearance of adhesions and scars, which leads to a decrease in the intestinal lumen and even to fusion with nearby organs.

Classification

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

The development of a 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 relapsing 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 have not been provided with appropriate medical care in the acute course of the disease. In this case, scars and adhesions appear in the tissues of the appendix, the lumen narrows, due to which, 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 blurred picture of symptoms in both women and men. The main symptom of the disease in this case is a regularly occurring aching mild pain in the right side, at the location of the appendix.

Other signs of chronic appendicitis include:

heaviness, flatulence, presence discomfort in a stomach;
mild nausea;
indigestion;
lack of appetite;
frequent stool disorders - diarrhea or constipation;
chronic subfebrile temperature body.

Soreness can increase with heavy exertion (due to increased pressure inside the peritoneum), at the time of emptying, with coughing. There are changes in the work of the digestive tract - constipation and diarrhea. In case of exacerbation, vomiting and nausea occur.

It is very important to diagnose and start treating chronic appendicitis as early as possible, since the constant presence of a focus of infection in the body, of course, does not affect its work in the most favorable way. Moreover, it is fraught with perforation of the appendix with the subsequent development of peritonitis, which can cause the death of the patient.

Chronic appendicitis - symptoms in women

Initially, signs of appendicitis in women are manifested by pain from the gastrointestinal tract. The pain spreads to the right lower abdomen and intensifies during a gynecological examination.

During the period of hormonal changes (for example, during pregnancy or menstruation), the pain is pronounced, localized in the ovaries and vagina. Against the background of appendicitis, failures occur in the cycle. In the process of making love, as well as after it, spasms occur, severe pain in the area of the vagina.

Diagnosis and treatment

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

Diagnostic measures to detect chronic appendicitis:

Soreness in the right iliac region, increased pain when lying on the left side, when bending right leg - these signs raise the 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, pain spreads to the entire abdomen.
Clinical blood and urine tests. Not sufficient to make a diagnosis, but still important companion methods to confirm or rule out a disease.
X-ray with contrast agent. This study helps to identify the obstruction of the hole connecting the process with the caecum. Also, radiography can show fibrous adhesions, accumulations of feces.
Ultrasound diagnostics. simple and safe method studies to quickly confirm the diagnosis. During the study, not only the condition of the appendix is assessed, but also other abdominal organs.
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 in the anterior abdominal wall. This method not only makes it possible to make an accurate diagnosis, but also allows you to immediately perform the removal of the appendix when 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 disease;
Gynecological diseases.

Treatment of chronic appendicitis is prescribed the same as in the acute form of the disease - surgical removal of the inflamed process. Appendectomy can be performed either laparoscopically or open way- 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 unexpressed symptoms, conservative treatment is used - taking antispasmodic drugs, physiotherapy, elimination of intestinal disorders.

Postoperative period

Within two days after the appendicitis was excised, the patient was prescribed bed rest. Appoint antibiotic 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 the operation. Prior to this, sudden movements, muscle tension should be avoided. abdominal wall to avoid cutting the seam. Recovery muscle tissue takes several months. A small pale scar remains on the skin, which can be seen in the photo.

The period when you can return to your usual lifestyle depends on the type of appendectomy and the nature of the course 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 weight lifting - only after 3-6 months. Refrain from visiting the bath or sauna for at least 3-4 weeks.

Diet

At conservative therapy and during rehabilitation period After the operation, a special diet must be observed:

Refuse spices, smoked meats, canned food, sweet carbonated drinks.
It is recommended to exclude strong black tea and coffee. Worth eating green tea, fruit drinks and compotes.
It is necessary 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 a visit to the doctor or be inattentive to the "signals" of your own body in the form of pain attacks, hoping for folk remedies, strictly prohibited! Herbal medicine and homemade recipes are useful as additional measures to strengthen the body and improve bowel function, as well as in the fight against pathogens.

Disease prevention

Special preventive measures does not exist. It is recommended to lead healthy lifestyle 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. Consider the main signs, symptoms and treatment of appendicitis.

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Chronic appendicitis and its symptoms in women

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

The paroxysmal state may take some time. Any movements of the patient are 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 appendicitis attacks:

Lack of stool or diarrhea;
Vomiting and occasional nausea;
Pain when examining an obstetrician-gynecologist;
Change in temperature to a maximum at night;
On palpation of the patient in the supine position with the right limb raised, the induration and process 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 that will be cholecystitis, urolithiasis disease, gynecological diseases, ulcer attacks.

Possible causes of the disease

Chronic appendicitis refers to inflammatory processes, all signs of which are sluggish and appear in the region of the caecum, located in the right lower abdomen. Similar phenomena are noted 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 provoke the occurrence of an inflammatory process in the body;
Clogging of the colon with feces, intoxication begins;
Blockage of the arteries supplying the appendix;
Gynecological diseases that are associated with the pathology of the uterus;
Prolonged abuse of unhealthy and fast food;
hereditary factors;
Problematic release of contents from the appendix.

Depending on the underlying cause, the disease is:

Residual - pain after acute appendicitis;
Recurrent - signs of this form appear rapidly and sharply: an upward change in body temperature, unbearable pain;
Quiet course - it is difficult to diagnose, because it is asymptomatic, no attacks in the form of cramping pains 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 white plaque in the language;
Change in body temperature upward;
Pain in the lower right side, often near the testicle.

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

Diagnostics of the chronic form

The main role in the treatment is played by the diagnosis, which can be carried out by 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 introduced into the body, which reveals changes in the intestine, the presence of stones and stenosis in the appendix.
Holding laboratory tests(blood, urine) helps to establish inflammatory processes in the body.
A colonoscopy is a procedure that helps to rule out colon tumors.

If acute appendicitis has been established in the anamnesis, the diagnosis of chronic appendicitis is simplified many times over. The diagnosis can be made by palpation. In chronic appendicitis, the skin on the right side of the groin appears loose.

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

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

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

Self-diagnosis chronic inflammation appendix is ruled out because there are many diseases that are similar in symptoms to appendicitis. Delays in 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 a surgical intervention, a detailed examination of the patient - and laboratory tests.

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

urolithiasis;
Stomach ulcer;
Crohn's disease;
Neoplasms of the ovaries;
Intestinal obstruction;
False pregnancy;
Endometritis.

There are many diseases with similar symptoms. Before cutting the abdomen, it is necessary to 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, adherence to a certain diet, since ignoring it leads to unbearable pain, disruption of the entire gastrointestinal tract. The process of recovery and the absence of complications after surgery depend on how accurately the diet is followed.

Appendicitis provides surgical operation, 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 a little time, after it is necessary to comply strict diet which is directed to:

To restore tissues of disturbed sections of the intestine;
Minimization of the load on the digestive system;
Recovery of the digestive tract.

Dietary food after removal of the appendix requires a daily slow intake of a small amount of food with a liquid-like consistency into the digestive tract. The essence of the diet after the removal of the appendix is to fortify the patient's body.

In the first 12 hours after the operation, the patient is forbidden any food. All that can be done is to wet the patient's lips with distilled water to avoid drying them out.

The approach is related to the prevention of infection digestive tract with the help of food. After surgery, all tissues are fragile and not completely healed.

What is the duration of dietary nutrition depends on the personal characteristics of the body and the speed of the recovery process. Monitoring of recovery 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 obliged to start eating in small portions;
Swallowing whole is unacceptable, each piece is chewed for a long time;
Initial nutrition should be predominantly "hungry";
The consistency and quantitative composition of the food consumed must comply with the daily recommendations of the attending physician;
How the diet will change depends on the patient himself.

After the operation to remove the appendix, all food should be consumed in a puree form.

No fatty, salty, acidic 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.

With proper adherence to dietary nutrition, the healing process will make itself felt 2 weeks after the operation.

Prohibited products for the patient

Salt and any foods with an increased 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, lactic acid bacteria can provoke fermentation processes and bloating.

Approved Products

Zucchini and pumpkin;
chicken broth;
Yoghurts;
Low-fat varieties of meat and fish in a finely processed form;
vegetable soups;
Teas, kissels, compotes.

All of these dishes should be consumed warm. Excessive consumption of them helps to worsen the digestibility of food and the formation of the gas formation process.

Treatment of chronic appendicitis

The use of any physiotherapy procedures until the diagnosis is fully established is prohibited.
It is forbidden to take any medicines, painkillers.
Treatment of appendicitis begins with the introduction of intravenous drugs.
The further method of treatment depends entirely on the form of the disease.
At the first stage, with timely seeking medical help, the risk of perforation of the appendix is not so great. For these patients, conservative treatment with antibiotics is recommended to minimize inflammation. Patients with this diagnosis do not require urgent surgical intervention. Preparation for an appendectomy is carried out gradually.
If the attacks last for a week, the patient, in addition to antibiotic treatment, is prescribed a procedure for outflow of an abdominal abscess.
Without surgical treatment removal of the appendix is impossible. And the sooner the patient consults a doctor, the more favorable the prognosis will be.

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

Transluminal surgery - involves the introduction through the genitals of instruments that visually assess the patient's condition, which later allows you to determine the method of the operation.

If the examination reveals that appendicitis has passed into a perforated form, antibiotic treatment until it disappears completely clinical signs appendicitis.

Help of folk remedies

The 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 with trouble for the patient.

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

Apply folk methods worth after consultation with the attending physician.

Decoction of fenugreek.

A teaspoon of seeds brewed with a glass of boiling water for an hour is excellent tool for the rapid separation 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 digestive tract. Patients are not threatened 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. Products can be used together or separately. The composition strengthens the immune system.

Possible consequences and complications

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

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

- a sluggish form of the inflammatory process in the appendix of the caecum, 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 exertion; nausea, flatulence, diarrhea or constipation, bladder, vaginal or rectal symptoms. Diagnosis of chronic appendicitis is based on the exclusion of other possible causes of this symptomatology and may include the study of the anamnesis, the conduct of a survey radiography, irrigoscopy, colonoscopy, ultrasound and other differential diagnostic studies of the abdominal organs. Treatment of chronic appendicitis with unexpressed manifestations is conservative, with persistent pain syndrome, appendectomy is indicated.

General information

Chronic appendicitis, in contrast to its acute form, is a rare disease in gastroenterology. In chronic appendicitis against the background of sluggish inflammation, atrophic and sclerotic changes in the appendix, growths of granulation tissue, scars and adhesions can develop, leading to obliteration of the lumen and deformation of the process, 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 presence in the patient's history of one acute attack, which ended in recovery without surgical intervention. In the chronic relapsing form, there are repeated attacks of acute appendicitis with minimal clinical manifestations in remission. A number of authors also distinguish primary chronic (attackless) appendicitis, which develops gradually, without an acute attack preceding it.

The residual (residual) form of chronic appendicitis is a consequence of a previous attack of acute appendicitis, which stopped without surgical removal process. At the same time, after subsiding of acute manifestations in the caecum, the conditions for maintaining the inflammatory process remain: adhesions, cysts, kinks of the appendix, hyperplasia of the lymphoid tissue, making it difficult to empty it.

Violation of blood circulation in the affected blind process contributes to a decrease in local immunity of the mucous membrane and activation of pathogenic microflora. Relapse of appendicitis is possible, as in the absence of it surgical treatment, and after subtotal appendectomy, leaving a process with a length of 2 cm or more.

Symptoms of chronic appendicitis

The clinical picture of chronic appendicitis is characterized by a predominance of implicitly expressed, blurred symptoms. Chronic appendicitis is manifested by a feeling of discomfort and heaviness, dull aching pains in the right iliac region, constant or occurring sporadically, after physical activity and dietary errors. Patients with chronic appendicitis may complain of digestive disorders: nausea, flatulence, constipation or diarrhea. At the same time, the temperature often remains normal, sometimes in the evenings it rises to subfebrile.

In chronic appendicitis, other symptoms may also be observed: vesical (painful and frequent urination), vaginal (pain during gynecological examination), rectal ( pain during rectal examination). Repeated attacks of acute inflammation of the blind process are manifested by 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, while history 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 a chronic one.

Indirect signs of chronic appendicitis on palpation of the abdomen may be local tenderness in the right iliac region, often a positive symptom of Obraztsov, sometimes positive symptoms of Rovsing, Sitkovsky.

For the diagnosis of chronic appendicitis, X-ray contrast irrigoscopy of the large intestine is necessarily performed, which makes it possible to detect the absence or partial filling of the blind process with barium and slowing down its emptying, which indicates a change in the shape of the appendix, deformation, narrowing of its lumen. Colonoscopy helps to reject the presence of neoplasms in the caecum and colon, and plain radiography and ultrasound in the abdominal cavity. Clinical analyzes of blood and urine of a patient with chronic appendicitis, as a rule, without pronounced changes.

In primary chronic appendicitis, the diagnosis is made by exclusion of other possible diseases abdominal organs, giving similar symptoms. It is necessary to carry out differential diagnosis chronic appendicitis with gastric ulcer, Crohn's disease, irritable bowel syndrome,

V postoperative period antibiotic therapy is required. Long-term results after surgical treatment of chronic appendicitis are somewhat worse than after acute appendicitis, since the development of the adhesive process is more often noted.

If a patient with chronic appendicitis has unexpressed symptoms, conservative treatment is used - taking antispasmodic drugs, physiotherapy, elimination of intestinal disorders.

Macroscopic changes in the appendix in chronic appendicitis can be so subtle that they can be detected only with morphological study remote process. If the blind process turned out to be unchanged, there is a possibility that surgery can further aggravate the existing pain syndrome, which served as the basis for an appendectomy.