Recurrent pain in right lower quadrant- chronic appendicitis versus stone in urinary tract

Abstract

INTRODUCTIONA 16 years old male patient complained of mild, intermittent pain in RLQ (right lower quadrant) of abdomen were receiving treatment for stone in urinary tract, as shown in USG abdomen for last 6 months in SOPD. One day he landed in hospital with abscess in right iliac fosa. He was operated upon and Appendicectomy was done. The histopathology report of the appendix showed chronic inflammatory changes. Few surgeons concluded patient receiving frequent consultation due to repeated abdominal pain chronic appendicitis should be considered as one of the cause in DD of recurrent pain in RLQ.1 Atypical clinical course with repeated attack in some individual does not resemble the features of appendicitis.2 Marcotty MW et al showed in 2/3 of the patient with so called chronic appendicitis does not resemble in their sign and symptoms with that of pathological and anatomical findings, they recommended a strong indication of operation in all 50 patient, 49/50 patients were free from pain within one year follow up. The sequence of events in patient and similar cases reported by many authors provides ample ground in favour of chronic appendicitis as a possible diagnosis in these patients to exists even in presence of small stone in ABSTRACT Background: At times, patient undergoing treatment for stone (4mm-6mm) in urinary tract beyond 6-8 weeks keeps on complaining mild, intermittent pain in RLQ, Central abdomen with nausea without urinary symptoms. In these cases, appendicectomy was performed. Post-operative relief and histopathology revealing inflammatory changes in appendix validated the procedure. Methods: This study was conducted in department of surgery of Rajshree Medical and Research Institute of Bareilly, Uttar Pradesh, India. India. 35 patients of ages between 14-65 years, mean being (39.5 years). Male female ratio being (2.5:1) who were suffering from recurrent pain in RLQ and being treated for stone in urinary tract (4-6 mm) were selected for the study. These patients were already received treatment for Urolithiasis for 6-8 weeks but proved to be of no avail. They were considered for appendicectomy. Macroscopic and microscopic results were analysed of the specimen rendered from 35 patients. Follow up results observed for complete one year. Results: On the firm belief that symptomatically these patients are more in favour of chronic appendicitis appendicectomy was performed. Post-operative relief of pain with no added morbidity or mortality provided rationale of the procedure. Histopathology of the remove specimen showed all changes pertaining to the chronic appendicitis. Conclusions: Obvious/oblivious, when patient is having both at the same time it really becomes perplexing to take the decision. Only experienced clinical skill decision taken yields positive results. Appendicectomy done in presence of small stones in urinary tract and relief patient received in present study proved the point.