Chronic appendicicts?

  I have been having ongoing abdominal/pelvic pain for over one
  month. I was diagnosed with the flu (originally) and have been
  to see doctors 5 times.  This week I had a barium enema which
  revealed that my appendix "did not fill."  Furthermore, I was
  told that my appendix was low - in my pelvis.  I was shuttled off
  to a surgeon, who then took a wait an see approach.  I am very
  uncomfortable despite anti-inflammatories (naprosyn) and pain
  medication  (hydrocodone). While I realize that I do not have
  a ruptured appendix, the fact that it doesn't fill alarms me.
  Every doctor  I have seen has commented on the "fullness" of my
  RLQ.  It is obvious just by looking at my abdomen.  I do not
  have a fever, or abnormal  white cell count.  I DO have rebound
  tenderness, reduced appetite,and difficulty with bowel
  movements.  I do not want to have acute appendicitis, is there
  any reason that the surgeons should not go in and take it out
  now?  I am miserable - unable to work or go to school.  Since
  I have been "waiting and seeing' for over a a month with
  no relief, is it reasonable for me to DEMAND an appendectomy?
  see another doctor about getting treatment? Should I wait
  and see if it will rupture, mend itself or ????
  Thank you,
  Debra

[HFHSM.D.-ab]

_

Dear Debra:
I am sorry to hear about your abdominal pain.  There are several  different causes for abdominal discomfort in the lower abdomen/pelvis (see below).  first, you should not be alarmed by the fact that your appendix does not fill during a barium enema.  Many people with normal appendix do not have  visualization during a barium enema.  
Second, surgeons are reluctant to operate unless there is strong evidence to suggest that removing your appendix will make you better.  It would be unfortunate if you had an operation with the associated discomfort and continued to have your initial pain.  I do not suggest that you demand an operation.  If you have a physician in whom you have confidence, you should talk to him/her about possible causes for your pain and what tests or treatments should be done.   Close follow-up by your doctor with repeated examinations will reassure you and the physician that a surgical prblem is not smoldering.  Third neither you or your doctor want to risk a ruptured appendix because of the risks associated with the intra-abdominal infection. Your physician will offer you surgery if there is concern regarding an appendiceal perforation.
What could be causing the pain if it is not appendicitis?  There are a number of possibilities.  Pelvic disease i.e. ovarian inflammation, ruptured ovarian cyst can cause pain that simulates appendicitis.  Small intestinal or colonic disease, specifically Crohn's Disease must be considered.  Finally, the physician should consider irritable bowel syndrome, a condition of abdominal pain and altered bowel function.  I suggest that you discuss with your physician the following tests (if they have not yet been done): pelvic examination, pelvic ultrasound, small bowel X-ray and possibly colonoscopy.  

Best of luck.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Fogel, one of our experts in the treatment of gastrointestinal disease.  He would be happy to meet you and to work with you regarding the cause of your symptoms.
HFHSM.D.-ab
*keywords: abdominal pain, appendicitis, pelvic inflammatory disease, ovarian cyst, Crohn's disease
0.5