Grumbling appendix is an old term used to describe chronic appendicitis. Chronic appendicitis shares many qualities with acute appendicitis, which is the more common of the two conditions. Both involve the inflammation of the vermiform appendix resulting in pain and discomfort in the lower right quadrant of the abdomen. The difference between the two is that acute appendicitis requires immediate medical intervention and removal of the appendix, whereas chronic appendicitis does not. Rather than the sudden, excruciating pain associated with acute appendix problems, grumbling appendix pains occur gradually.
Doctors are able to identify grumbling appendix by using a combination of approaches. First, the doctor localizes the patient's pain, and checks that it is at or around the site of the appendix. The pain for grumbling appendix is chronic and mild to moderate in nature, not severe as found in acute appendicitis. Other common symptoms include nausea and vomiting, but they are not always present. The physical exam involves the doctor pushing on the appendix to ensure that is the source, and the patient does not have the severe rebound pain associated with acute appendicitis. Next, the doctor refers the patient to have an abdominal computer tomography (CT) scan. The radiologist's report for chronic appendicitis will contain information about any abnormalities of the appendix. These abnormalities could include swelling and abnormalities of the appendix's contents. The contents of the appendix appear darker on the CT than the tissue of the outside of the appendix. Any findings that indicate acute appendicitis will rule out chronic appendicitis as the cause.
Unlike acute appendicitis, chronic appendicitis does not come on suddenly and continue to get worse. Often, a grumbling appendix pain worsens at a slow rate. It can take weeks for a grumbling appendix to cause problems worrisome enough to visit a doctor.
Chronic appendicitis often presents with features close enough to acute appendicitis that surgery is the doctor's recommendation. Although the symptoms are milder, doctors don't want to take the chance that it is acute appendicitis that is slow-developing.
Chronic appendicitis is usually treated with a powerful antibiotic to fight the infection in the appendix. Often, the course of antibiotics is prolonged and the dosage extremely high to prevent progression to acute appendicitis. Another treatment for chronic appendicitis is surgical removal. This prevents any further pain, as well as the risk associated with possible future acute attacks.
A person with any sudden or severe lower right quadrant pain needs to receive medical care immediately. While chronic appendicitis is not a medical emergency, acute appendicitis is an emergency and can cause death if left untreated. Since there is a risk of developing acute appendicitis from chronic appendicitis, go over all the risks with a physician and discuss the best course of treatment with that in mind. Treatment is necessary to avoid progression to acute appendicitis.