Appendix tissue fibrosis

Introduction Chronic appendicitis refers to chronic inflammatory lesions of the appendix left after the acute inflammation of the appendix subsides, such as fibrous connective tissue hyperplasia, stenosis or occlusion of the lumen, distorted appendix, and adhesion to surrounding tissues. The appendix wall is hypertrophic and hypertrophic. It is fibrotic and short and tough. The surface is grayish white. The appendix is thickened, shortened and hardened. There are perivascular lymphocytes and eosinophil infiltration under the mucosa or subserosal, and some foreign bodies can also be seen. The cells are present. Sometimes the wall of the appendix is fibrotic and the lumen is narrow, and even occlusion into a cord is similar to the aging atrophy of the appendix. Stenosis and occlusion spread from the tip of the appendix to the root. If only the root is occluded, the distal lumen can be filled with mucus to form a mucous cyst. After the chronic inflammation of the appendix, it can be curled by itself, or surrounded by a large number of fibrous adhesions, and there are fecal stones or other foreign matter in the lumen.

Cause

(1) Primary chronic appendicitis: characterized by insidious onset, slow development of symptoms, and a long duration of disease, months to years. There was no history of acute attack at the beginning of the disease, and there was no repeated acute attack in the course of the disease.

(2) Secondary chronic appendicitis: It is characterized by the first acute appendicitis after the onset of non-surgical treatment, or more self-remission, followed by clinical symptoms, long-term treatment, acute or multiple episodes in the course of the disease.

an examination

Diagnosis of chronic appendicitis is not easy, and its diagnosis must be based on the exclusion of all right lower abdomen pain and tenderness. Therefore, the diagnosis of chronic appendicitis should be cautious.

Invisible or irregular pain in the right lower abdomen is the main clinical manifestation, and occasionally other gastrointestinal symptoms such as increased frequency of bowel movements or abdominal fullness. Mild tenderness in the right lower quadrant is the main sign.

Repeated (intermittent) episodes of appendicitis have a clear history of acute appendicitis. Intermittent recurrent episodes later, but all of them are subacute. Symptoms such as reflex stomach discomfort, bloating, constipation, etc., are more definitely the right lower quadrant pain and local tenderness, not serious. After multiple episodes, the right lower abdomen can also reach the cable-like hard appendix. It is painful to touch, so it is easy to identify clinically. As for the history of no acute appendicitis, the medical history is unclear, the symptoms and signs are not typical, and the diagnosis is difficult. Patients often have frequent right lower quadrant cramps, the degree of pain is different, most of them are dull pain, usually have more symptoms of gastrointestinal diseases, such as loss of appetite, abdominal distension, postprandial stomach discomfort, constipation or mild diarrhea, etc. , no features. The more and more concentrated clinical manifestations are pain and tenderness in the right lower quadrant, which is more extensive, but still centered on the appendix.

Differential diagnosis

It is not difficult to diagnose the repeated (intermittent) episodes of appendicitis with a history of acute appendicitis, and the symptoms are obvious. However, the diagnosis of chronic (obstructive) appendicitis without a history of acute appendicitis is a key issue. Barium enema examination helps a lot. The most typical finding is that the tincture fills the appendix and it is found that the appendix is narrow and irregular, irregularly filled, twisted, fixed, and can be tenderly developed to the appendix. Sometimes the appendix is not full or only partially filled, local tenderness, can also be considered as the performance of chronic appendicitis. In addition, although the filling of the appendix is normal, the emptying delay is more than 48h, which can also be used as a diagnostic reference.

Diagnosis of chronic appendicitis is not easy, and diseases that can cause pain and tenderness in the lower right abdomen must be excluded. Therefore, the diagnosis of chronic appendicitis should be cautious.

Diagnosis of chronic appendicitis is not easy, and its diagnosis must be based on the exclusion of all right lower abdomen pain and tenderness. Therefore, the diagnosis of chronic appendicitis should be cautious.

Invisible or irregular pain in the right lower abdomen is the main clinical manifestation, and occasionally other gastrointestinal symptoms such as increased frequency of bowel movements or abdominal fullness. Mild tenderness in the right lower quadrant is the main sign.

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