Chronic appendicitis

The existence of such a form of inflammation of the appendix, as a chronic appendicitis in adults, and in children, many surgeons are questioned.

Preoperative diagnosis of this pathology, as a rule, is exposed on the basis of repeatedly occurring abdominal pains with localization in the right ileal region.

[1], [2]

Epidemiology

In recent years, there has been renewed interest in this complex and extremely important problem in abdominal surgery. Detailed study of clinical and morphological parallels in various forms of inflammation.

Using modern research methods (ultrasound scanning, endoscopic and morphological methods), the authors concluded that chronic appendicitis as a nosological form exists and is up to 5% among patients with painful abdominal syndrome.

[3], [4], [5]

Causes of the chronic appendicitis

What causes chronic appendicitis, as a rule, can not be established. The leading role in the emergence of a chronic process is played by the obstruction of the lumina of the appendix in dense calves. Just as in the case of acute appendicitis, the infectious and neurovascular, neuro-immune theory of the onset of chronic inflammation is considered. Point to the frequent combination of this pathology and parasitic diseases of the gastrointestinal tract (for example, enterobiosis).

[6], [7]

Pathogenesis

Chronic appendicitis, manifests itself most often in the form of an intermediate form of productive inflammation with hyperplasia of the lymphoid apparatus of the appendix, with a predominance of lymphohistiocytic infiltration, as well as an increase in the amount of connective tissue characterizing the processes of fibrosis or sclerosis in all layers of the appendix, up to their complete atrophy.

[8], [9], [10], [11]

Symptoms of the chronic appendicitis

Symptoms of chronic appendicitis are characterized by a paroxysmal course of the disease with local abdominal pains lasting from 6 months to 4 years. Most often, suspicion of the presence of a slow pathology from the side of the appendix occurs 6-12 months after the onset of the disease. Periodic painful attacks in the right ileal region, which arise mainly after physical exertion, moving games, with errors in the diet, reduce the quality of life of the child. In most cases, after another such attack, the child is hospitalized with a diagnosis of "acute appendicitis." But further data for the acute pathology of the abdominal cavity can not be identified.

In most patients, the pain is localized in the right ileal region less often - in the lower abdomen, near the umbilical region and the right abdominal areas. In some patients, attacks of pain in the abdomen are accompanied by nausea, vomiting, constipation or diarrhea.

[12], [13], [14], [15],

Forms

The following classification is proposed:

• Primary chronic appendicitis. In the anamnesis there are no objective data on the acute acute inflammatory process in the vermiform appendage.
• Secondary chronic appendicitis. Changes in the appendix are caused by a sharp inflammatory process in the form of an appendicular infiltrate or an appendicular abscess.

[16], [17], [18]

Diagnostics of the chronic appendicitis

With objective examination, palpation is determined by moderate soreness in the right ileal region. In some patients, weakly positive symptoms of peritoneal irritation are noted.

Laboratory and instrumental research

In principle, a thorough examination of patients with periodic abdominal pain, including laboratory and instrumental techniques. The most informative diagnostic method is the ultrasound scan of the abdominal cavity organs. It is also justified to perform FEGS for the exclusion of inflammatory diseases of the upper gastrointestinal tract, the most likely cause of the pain syndrome.

Only after excluding any pathology from the abdominal and pelvic organs can pain abdominal syndrome with the pathology of the appendix.

The following are considered ultrasound criteria of chronic appendicitis:

• an increase in regional mesenteric lymph nodes, visualized in the form of structures of reduced echogenicity, in the absence of increased:: other groups of mesenteric lymph nodes:
• presence of 3-5 ml of fluid in the right ileal fossa:
• unexpressed hypoechoigenia of the muscular layer of the appendix, diameter within 4-6 mm, but not uniform throughout, with alternating sites of constriction up to 3 mm and widening up to 6 mm;
• absence of peristalsis, local soreness with pressure in the projection of the appendage:
• presence of stony stone in the lumen of the appendix.

[19], [20]

Differential diagnosis

It should be borne in mind that in childhood, the spectrum of diseases with similar symptoms is extremely extensive. This is directly the pathology of the ileocecal angle: inflammatory (mezadenitis, terminal ileitis, Crohn's disease of the caecum), malformations (caecum mobile, membrane, Lane ligament, embryonic cords in the area of the appendix), functional pathology (bauginospasm or buginienic membrane deficiency), benign, and sometimes malignant neoplasms. In turn, many diseases of the gastrointestinal tract, biliary system, urinary tract and gynecological pathology in girls have a clinical picture similar to chronic appendicitis. In addition, it is known that this form of inflammation of the appendix is of greatest complexity not only for clinicians, but also for morphologists due to the lack of convincing macroscopic and microscopic data.

Treatment of the chronic appendicitis

Patients diagnosed with chronic appendicitis are diagnosed with a diagnostic laparoscopy with a thorough revision of the abdominal organs, appendectomy.

Forecast

Patients operated on for such a pathology as chronic appendicitis are to be observed for 6 months after the operation. It must always be remembered that only careful study of the long-term results of treatment of children, perhaps, lends clarity to the solution of this complex problem.