title: Chronic appendicitis "syndrome" manifested by an appendicolith and thickened appendix presenting as chronic right lower abdominal pain in adults.
abstract: In this short report, we describe a small series of adult patients with chronic appendicitis presenting with chronic right lower quadrant abdominal pain. The clinical presentation was unusual and atypical for classic appendicitis because of the absence of fever, peritoneal tenderness on focused graded compression of the abdomen, and leukocytosis. Computed tomography (CT) findings included the presence of an appendicolith and appendiceal thickening, without mesenteric infiltration, abscess, or collection. In this series, the appendicolith appeared to represent a marker rather than an actual cause of appendicitis. Focused CT scans with additional lung and bone windows proved optimal in detecting appendicoliths, which were not visible on the scout localizer scans, despite windowing modifications. Our findings suggest that chronic appendicitis may be a phenomenon unique to adults and should be included in the differential diagnosis of chronic right lower quadrant pain in patients seen in the emergency room setting. Surgery is curative in such patients, although expectant management is an alternative when tolerated by the patient.
authors.affiliation: Nova Southeaster University, 5732 Canton Cove, Winter Springs, FL 32708, USA. giulianomd@att.net
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Giuliano
authors.forename: Concetta
authors.initials: C
authors.lastname: Giuliano
authors.forename: Fabio
authors.initials: F
authors.lastname: Pinto
authors.forename: Mariano
authors.initials: M
authors.lastname: Scaglione
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000328:Adult; D001064:Appendicitis / Q000150:complications / Q000000981:diagnostic imaging*; D002137:Calculi / Q000150:complications / Q000000981:diagnostic imaging*; D002429:Cecal Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013577:Syndrome; D014057:Tomography, X-Ray Computed