Recurrent "chronic"appendicitis ; is it a myth ? is appendicectomy indicated?

Abstract EN

The existence of recurrent "chronic " appendicitis and its treatment outcome are controversial .

The aim of this study was to investigate its existence as an entity and to analyse its treatment outcome with appendicectomy .

Prospective study included patients with recurrent "chronic " appendicitis admitted in Hilla General Teaching Hospital from 1992 through 2001 and submitted for appendicectomy .All patients were investigated by general urine analysis , full blood Count , and abdominal ultrasonography .

All appendices were examined grossly by the surgeon for evidence of chronic appendicitis.

Histopthological examination was done for 17 (29.3%) patients and not all .Followed up period was for 2 to 6 years for disappearance of symptoms or appearance of other diagnoses Out of 721 patients undergoing appendicectomy , 63 of them had recurrent "chronic" appendicitis .

.Follow up results for 2 to 6 years were possible in 58 patients , 32 ( 55%) females and 26(45%) males .

Age ranges from 6 years to 21 years with a mean of 13years .

Fifty-eight patients had abdominal pain and mild tenderness in the right iliac fossa .

There were no significant changes on urinary analysis , full blood count or abdominal ultrasonography.

In 54 patients there were gross evidences of chronic inflammation in the appendix and the surrounding tissues.

Histopathological examinations were assessed in only 17 (29.3%) patients and 16 of them had evidences of chronic inflammation with lymphoid hyperplasia , and 1 carcinoid tumour of the appendix .

Postoperatively , 54 patients were without complications , 1 developed adhesive intestinal obstruction, 3 patients developed wound infection.

There was no operative death.

On follow up period 56 patients were completely pain-free and the other two patients showed moderate improvement and no patient developed a diagnosis other than what was presented to.

The study concluded that recurrent "chronic " appendicitis does exist as a real entity and not a myth because some patients with appendiceal disease have atypical course, not exactly similar to classical picture of acute appendicitis and their appendices showed gross and microscopical evidence of chronic inflammation.

In addition to that and because this study showed that significant number of these patients become symptom-free after appendicectomy , we believe that appendicectomy is a good treatment for this disease .