Chronic appendicitis: two case reports 

Abstract

Background Chronic appendicitis is a condition unfamiliar to many physicians and is often referred to as a controversial diagnosis. This can give rise to diagnostic delay. Case presentation We present two cases of chronic appendicitis: a Caucasian female aged 21 years and a Caucasian male aged 34 years. The patients had different clinical presentations, which led the initial investigations in very different directions—tropical infectious disease and possible malignancy, respectively. In both cases, radiological imaging was the key investigation leading to the final surprising diagnosis. Conclusion With these two case stories, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in younger patients with chronic or recurrent abdominal pain, particularly if the pain is located in the lower abdomen and is accompanied by fever.

Chronic Appendicitis: Possible Differential Diagnosis in Patients with Chronic Abdominal Pain

“…To conclude, it is hard to differentiate between acute and chronic appendicitis, since the latter is very rare. It is believed that the only, or better to say, main difference between acute and chronic appendicitis is the duration of pain and the clinical picture—the symptoms are often milder than in acute appendicitis, which can lead to misdiagnosis and diagnostic delay [ 7 ].…”

“…The next most common step is surgery appendectomy, which can be laparoscopic or laparotomy. The optimal treatment for this condition is unknown [ 7 ].…”

Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan

“…Chronic appendicitis can sometimes be radiologically tricky even by CT scan [13,14]"Misty mesentery" on imaging is a term used to describe the radiological presentation of mesenteric fat that has been invaded by inflammatory cells, fluid, tumors, and/or fibrosis can be seen in other cases like Pancreatitis, diverticulitis, inflammatory bowel disease, TB, lymphoma, and mesenteric panniculitis which should be also kept in the differential diagnoses [15,16]. In this particular case, both ultrasound and CT scan results unfortunately led to a misdiagnosis, as they indicated signs of perforation and the presence of a phlegmon collection.…”

Incidental Appendico-Ileal Fistula in a Patient With Adhesive Intestinal Obstruction: A Case Report

“…In complicated appendicitis, there is gangrene of the appendiceal wall with or without perforation and localized or diffuse peritonitis [1,2]. On the other hand, recurrent or chronic appendicitis is an uncommon but well-recognized presentation of appendicitis [3][4][5]. There is luminal obliteration with chronic inflammatory changes and fibrosis in the appendiceal wall [3,4].…”

“…On the other hand, recurrent or chronic appendicitis is an uncommon but well-recognized presentation of appendicitis [3][4][5]. There is luminal obliteration with chronic inflammatory changes and fibrosis in the appendiceal wall [3,4]. The patient may be asymptomatic or have chronic or recurrent abdominal pain.…”