Appendicitis??

[Skipper47]

I have had intermittent LRQ pain for about 3 months becoming more frequent in nature. It is intense, level 9, with rebound severe pain. It subsides after a couple of hours and there are no residual symptoms. No fever, etc. only very localized LRQ pain. It hurts to walk and I must sit down with great care, I have performed some of the tests for appendicitis such as lying supine with my right leg bent and pushing over to the left...this results in much pain. Having been an EMT for many years I understand this could be appendicitis, however, I am confused about the pain free lapses. I live in the middle of no where with poor hospitals about 2 and a half hours away. I am hesitant to spend 5 hours in an ER and then having no pain when I am finally seen. Does it make sense to have classic appendicitis symptoms that go completely away for a few days at a time over a 3 month course? What has prompted my question is that I had two episodes yesterday, one in the morning and a very severe bout in the evening. I keep thinking this will just go away especially when I'm pain free and I forget about it. I know you will say I need checked out and I agree in my brain, but the other part of my brain wants to know if these long pain free periods over the course of 3 or so months without a perforation are typical of appendicitis issues? So, in summary, I am curious about the long course of this and the pain free periods. Thank you.

[Joseph Sclafani, M.D.]

Thank you for your question. Without being able to review your entire history it will not be possible to give you an exact answer, but generally speaking appendicitis should always be considered in the differential diagnosis (list of possible causes) of abdominal pain. However, I would not restrict the list to only appendicitis.

The typical presentation begins with periumbilical pain (pain around belly button) followed by anorexia (lack of appeitite) and nausea. The pain then usually localizes to the right lower quadrant as the inflammatory process progresses to involve the parietal peritoneum overlying the appendix. This classic pattern of migratory pain is the most reliable symptom of acute appendicitis. Vomiting may then occur, in contrast to the repeated bouts of vomiting that typically accompany viral gastroenteritis or small bowel obstruction. Fever then usually occurs, followed by the development of an elevated white blood cell count. Of course not all patients present this way. For example, not all patients lose their appetite.

The duration of symptoms without decompensation and perforation would be highly atypical. If one of my patients developed these symptoms for this period, I would definitely order a CT scan to answer what is causing your pain. If one of my patients had similar symptoms I would also evaluate them for nephrolithiasis (kidney stones) and inflammatory bowel disease. Ask your physician about basic blood work (CBC and comprehensive metabolic profile),  urinalysis, and most importantly a CT scan (94% sensitive and 95% specific for diagnosis of appendicitis.

Very Respectfully,
Dr. S

[troubadour]

Hi, Skipper, you may have chronic appendicitis (which does exist, please see my posts below), I had it:

http://www.medhelp.org/posts/Gastroenterology/does-chronic-appendicitis-exist/show/8469

http://www.medhelp.org/posts/Gastroenterology/roundworms-Ascaris--elevated-monocytes--eosinophils--abdominal-pelvic-pain/show/1369187?personal_page_id=903718#post_6249026

(pictures here:

http://www.medhelp.org/photo_collections/list/13948?personal_page_id=903718

and here:

http://www.medhelp.org/photo_collections/list/15453 )

It can be diagnosed by an upper GI X-ray with small bowel follow-through, and/or an Doppler ultrasound - the appendix must readily fill with contrast fluid in the X-ray (mine wasn't). The Doppler is more tricky, works well if you don't have a lot of fat around the belly (at the time I was quite thin). However, pain is a pretty good indicator, I would not hesitate to go to the doctor as soon as possible, good luck.