CHRONIC AND RECURRENT APPENDICITIS ARE UNCOMMON ENTITIES OFTEN MISDIAGNOSED

Those having chronic and recurrent appendicitis represent a small port ion of patients with disorders of the appendix. We present a series of nine patients who underwent appendectomy for chronic or recurrent app endicitis at The Johns Hopkins Hospital, Baltimore, Maryland, between July 1984 and October 1992. There were seven women and two men (median age of 30 years, range of 15 to 63 years). All patients presented wit h pain in the right lower quadrant or lower abdomen of three or more w eeks duration (mean of 16.0 +/- 8.4 months, range of three weeks to se ven years), had no alternative diagnosis to account for the symptoms, had pathologic evidence of chronic inflammation or fibrosis of the app endix and had complete relief of the symptoms after appendectomy. Alth ough the patients presented herein had clinical and pathologic evidenc e for recurrent or chronic appendicitis, careful review of the course of each patient before surgical referral revealed at least one episode of acute pain in the abdomen consistent with acute appendicitis manag ed by nonoperative means. This suggests that, while recurrent acute ap pendicitis and chronic appendicitis do occur, they can be avoided by t he accurate diagnosis and operative management of acute appendicitis. We conclude that acute appendicitis can resolve spontaneously and recu r repeatedly in the same individual; in the evaluation of a patient wi th abdominal pain, a history of prior similar episodes of pain should never dissuade one from considering the diagnosis of acute appendiciti s, and recurrent acute appendicitis: and chronic appendicitis should b e considered in the differential diagnosis of recurrent pain in the lo wer abdomen.