Title: The Hidden Agony of Chronic Appendicitis: A Long Road to Diagnosis
Introduction:
Elizabeth Svoboda’s story is a testament to the challenges of living with chronic appendicitis. For two decades, she endured excruciating pain in her lower abdomen, often mistaking it for symptoms of other conditions like irritable bowel syndrome (IBS). It wasn’t until college that she received a diagnosis, but it took nearly 20 years for her to finally find out what was tormenting her: chronic appendicitis.
Understanding Chronic Appendicitis:
Unlike acute appendicitis, which strikes suddenly and requires immediate surgery, chronic appendicitis is characterized by recurring episodes of abdominal pain that can last for weeks or even months. This condition, although rare, affects both adults and children and is often misdiagnosed due to its intermittent nature and milder symptoms.
Diagnosing Chronic Appendicitis:
Diagnosing chronic appendicitis is challenging due to the absence of official diagnostic criteria. It often becomes a diagnosis of exclusion, ruling out other conditions with similar symptoms, such as IBS, gastroenteritis, Crohn’s disease, or infectious diseases. CT scans and white blood cell counts, typically used to detect acute appendicitis, may not show abnormalities in chronic cases, further complicating the diagnosis.
The Controversy Surrounding Chronic Appendicitis:
The medical community still debates whether chronic appendicitis is a distinct condition or an untreated form of acute appendicitis. Due to its rarity, many doctors have yet to encounter a case themselves and may not be aware of the condition. The lack of definitive risk factors and unknown causes further add to the mystery surrounding chronic appendicitis.
The Consequences of Misdiagnosis:
While chronic appendicitis is not an emergency, delayed or incorrect diagnosis can have severe consequences. If left untreated, the inflamed appendix may eventually burst, leading to potentially life-threatening complications such as peritonitis or abscess formation. In rare cases, appendiceal cancer can also be masked by chronic appendicitis, emphasizing the importance of surgical removal rather than antibiotic treatment.
Raising Awareness for Timely Diagnosis:
Elizabeth Svoboda’s experience highlights the need for increased awareness of chronic appendicitis. With proper knowledge and awareness, healthcare providers can consider chronic appendicitis as a potential cause of recurring abdominal pain and undertake appropriate diagnostic measures.
Unique Insights: The Road to Recovery and Hope:
While chronic appendicitis poses significant challenges, surgical removal of the appendix offers relief for most individuals with this condition. Personal accounts, like that of Steven Teleky, who was diagnosed with chronic appendicitis after a series of intense pain episodes, emphasize the importance of prompt and thorough evaluation. By advocating for increased awareness, individuals like Svoboda and Teleky hope to spare others from enduring years of unnecessary pain.
Conclusion:
Chronic appendicitis, though rare, poses unique challenges in terms of diagnosis and management. Its intermittent nature and milder symptoms often lead to misdiagnosis or delayed treatment. However, as more case reports and scientific literature shed light on this condition, healthcare providers can better recognize and address chronic appendicitis, improving the quality of life for those affected. Increased awareness and understanding are key to ensuring timely interventions for individuals experiencing this hidden agony.
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August 18, 2023: Elizabeth Svoboda was just 15 years old when she developed attacks of shooting pain in her lower abdomen so severe that she had to lie in the fetal position for hours until it subsided. Every few weeks, and for the next 2 decades, the sensation of her would return, incapacitating her.
“I’ve been through labor, and I would say at worst, my pain was comparable to that,” said Svoboda, now 42, from California.
It wasn’t until college that she discussed her pain with a doctor who, without performing any tests or imaging, finally attributed it to irritable bowel syndrome (IBS): an intestinal disorder known to cause abdominal pain, gas, diarrhea, and constipation. .
“At that moment, I raised my hands and said to myself: ‘No one will be able to solve this,’” Svoboda said. “I just accepted that this was my normal state of being.”
Little did she know, it would take almost 20 years of pain to find out what was tormenting her: chronic pain. appendicitis. Although there is no official definition, a person is thought to have the condition when their appendix, the finger-like sac at the end of the colon, becomes inflamed and causes abdominal pain in regular, intermittent episodes that can last for weeks or months. , or years.
Chronic appendicitis is rare, according to current estimates. Studies have found that it occurs in about 1% of all cases of appendicitisand affects adults and children similar.
Appendicitis It is almost always acute, meaning it strikes suddenly and quickly gets worse, causing people to have emergency surgery to remove the organ. Occur in 7% of the US population, with 250,000 cases reported annually; most are diagnosed in people between the ages of 10 and 30, but anyone can get it.
Both the chronic and acute versions of the condition cause similar symptoms: pain that starts around the belly button and eventually moves to the lower right side of the abdomen, along with nausea, vomiting, fever, and loss of appetite.
The main difference between the two is time, he said Reezwana Chowdhury, MD, gastroenterologist and assistant professor of medicine at Johns Hopkins Medicine in Baltimore. Acute appendicitis usually presents within 24 to 48 hours, while chronic appendicitis can present in episodes that last several hours and recur randomly for at least a week, but usually longer.
Because people with chronic appendicitis have pain that comes and goes, and it’s usually not severe enough to warrant a trip to the hospital, it can often be misdiagnosed like many other conditions, Chowdhury said, including, among others, IBS, gastroenteritis, Crohn’s disease or an infectious disease. CT scans and white blood cell countswhich are often elevated in people with acute appendicitis, can also return to normal, making chronic cases even more difficult to detect.
Experts don’t know what causes chronic appendicitis, but like acute cases, it is thought to occur once the appendix becomes partially or completely blocked by hardened balls of stool, inflammation due to infection or other diseases of the intestine, or cancerous growths, said cherisse berryMD, chief of the Division of Critical Care Surgery at NYU Langone Health in New York City.
Appendicitis occurs randomly, he said, so there are no definitive risk factors that might make one person more likely to have it than another.
These unknowns, the researchers say, make it difficult to know if chronic appendicitis is the result of untreated acute appendicitis or if it is a completely different disease.
As rare as the cases are, chronic appendicitis has been gaining ground in the medical community as an increasing number of case reports about the condition are published in scientific journals. He first it was reported in 1949.
Still, the condition is considered a controversial diagnosis; many doctors have yet to treat a case themselves, and some do not know that it is a real medical phenomenon.
“I’ve never seen a case of chronic appendicitis and unfortunately I don’t know how often it’s in our differential for many patients we see,” Chowdhury said. “The problem is that there is no official diagnostic criteria, and it is usually a diagnosis of exclusion,” meaning that doctors diagnose the condition through the process of elimination.
Svoboda never received an official diagnosis. After excruciating pain landed her in the hospital just before Christmas 2012, a CT scan revealed that she had acute appendicitis and her appendix was immediately removed. It was only after extensive research and discussions with her father, who is a doctor, that Svoboda realized her condition was likely chronic.
“Had I had a doctor who knew how to look for chronic appendicitis, I could have found it sooner and certainly changed the course of my life during the 15+ years I had this pain,” said Svoboda, who says she has been pain-free since your surgery. “This is why I feel so strongly about raising awareness on this issue. If I could save people years of the kind of pain I had, I think it would be a great success.”
Prolonged misdiagnoses have consequences
Chronic appendicitis is not considered an emergency, but it can become one the longer it goes undiagnosed or misdiagnosed.
A the untreated appendix may eventually burst. The longer you wait to surgically remove the organ, the greater your chances of having the lining of your abdomen swell, called peritonitis, or a pocket of pus forming, called an abscess, which could spread an infection from the body.
More rarely, appendicitis can mask cancer of the appendix, which is why most doctors recommend that patients have surgery rather than opt for antibiotic treatment, Berry said. CT scans will not always detect cancers in the appendix, especially if they are low grade; in many cases, they can only be detected through lab work done on the appendix after it is removed.
Appendiceal cancer is thought to affect one to two people per 1 million each yearaccording to the National Cancer Institute, but studies show that it is becoming more common, especially in people under 50.
Otherwise, the consequence of a late or incorrect diagnosis is weeks, months or years of unnecessary pain. The good news: Studies have found that surgical removal of the appendix offers relief for most people with a chronic case.
Steven Teleky can attest to that. The 28-year-old San Francisco Bay Area resident began experiencing shooting pains around his belly button while participating in a baseball game in April. He eventually disappeared, so he thought lack of sleep was to blame. The following month, Teleky went to Portugal on a family vacation and the intense pain returned.
“With every right step, boomHorrible, shooting pain in the belly button,” he said. “Again, I chalked it up to anxiety about being somewhere new, or heck, maybe even a hernia, and brushed it off.”
A month after returning home, the pain returned in her lower right abdomen, this time causing extreme swelling in her pelvic area, as well as daily nausea that took away her appetite.
Last week Teleky went to the hospital. Although he was not in severe pain at the time, the medical assistant in charge of his care insisted that Teleky have a CT scan, which found moderate inflammation in his appendix. He was quickly diagnosed with appendicitis and had his appendix successfully removed.
At a follow-up appointment, his surgeon confirmed that he was dealing with chronic appendicitis and is now on the road to recovery.
“I am so thankful that even though I was in the ER without any real pain, the attending physician pressured me to get scans. Without her insisting on ruling out the worst case, who knows what would have happened,” Teleky said. “She really saved me a lot of headache, and she probably saved my life.”
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