Chronic abdominal pain is a common problem, and when the complaints are confined to the right lower quadrant, the question of chronic appendicitis is usually raised. Patients with genuine chronicappendicitis experience pain that lasts for 3 weeks or more. The history usually includes an acute illness at some time in the past, compatible with acute appendicitis, which was managed nonoperatively. On examination, the appendix is chronically inflamed or fibrotic. The symptoms resolve with appendectomy.
Chronic intermittent pain in the right lower quadrant is most often caused by something other thanappendicitis, such as Crohn’s disease or renal disease. Barium x-rays are sometimes helpful, particularly in children. In many patients, the diagnosis is not obvious. Appendectomy relieves symptoms occasionally, but laparotomy for chronic abdominal pain is generally unproductive in the absence of objective findings (eg, localized tenderness, palpable mass, leukocytosis).