Recurrent pain in right lower quadrant- chronic appendicitis versus stone in urinary tract

Vijai Prakash Srivastava, Ajai Agarwal, Shwetank Agarwal


Background: At times, patient undergoing treatment for stone (4mm-6mm) in urinary tract beyond 6-8 weeks keeps on complaining mild, intermittent pain in RLQ, Central abdomen with nausea without urinary symptoms. In these cases, appendicectomy was performed. Post-operative relief and histopathology revealing inflammatory changes in appendix validated the procedure.

Methods: This study was conducted in department of surgery of Rajshree Medical and Research Institute of Bareilly, Uttar Pradesh, India. India. 35 patients of ages between 14-65 years, mean being (39.5 years). Male female ratio being (2.5:1) who were suffering from recurrent pain in RLQ and being treated for stone in urinary tract (4-6 mm) were selected for the study. These patients were already received treatment for Urolithiasis for 6-8 weeks but proved to be of no avail. They were considered for appendicectomy. Macroscopic and microscopic results were analysed of the specimen rendered from 35 patients. Follow up results observed for complete one year.

Results: On the firm belief that symptomatically these patients are more in favour of chronic appendicitis appendicectomy was performed. Post-operative relief of pain with no added morbidity or mortality provided rationale of the procedure. Histopathology of the remove specimen showed all changes pertaining to the chronic appendicitis.

Conclusions: Obvious/oblivious, when patient is having both at the same time it really becomes perplexing to take the decision. Only experienced clinical skill decision taken yields positive results. Appendicectomy done in presence of small stones in urinary tract and relief patient received in present study proved the point.


Appendicectomy, Chronic appendicitis, Small stone in urinary tract

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Seidman, JD, Andersen DK, Ulrich, S, Hoy-GR Chun B. Recurrent abdominal pain due to chronic appendiceal disease. South Med. J. 1991;84(7):913-66.

Leardi S, Delmonaco S, Ventura T, Chiominto A, De Rubeis G, Simi M. Recurrent abdominal ain and "chronic appendicitis"; Minerva Chur. 2000;55(1-2):39-44.

Sarvin RA, Clausen K, Martin EW Jr, Cooperman M. Chronic and Recurrent appendicitis, Am J. Surg. 1979;137(3):355-7.

Mattei P, Saola JE, Yeo CJ. Chronic and recurrent appendicitis are uncommon entities often misdiagnose; J Am Coll Surg. 1994;1778(4):385-9.

Tamm EP, Silverman PH, Shuman WP. Evaluation of the patients with flank pain and possible ureteral claculus. Radiology. 2003;228:319-29.

Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteriic stones clinical guidelines pannel summary report on the management of urelateral calculi. J. Urol. 1997;158:1915-21.

Jones MW, Peterson AG. The correlation between gross appearance of the appendix at appendicectomy and histological exam. Ann R Coll Surg Engl. 1988;70:93-6.

Butsch DW, Jothi R, Butsch WL, Butsch JL. Recurrent appendicitis fact not fallacy. Postgraud Med. 1973;54(4):132-9.

Drezner JA, Harmmon KG. Chronic appendicitis presenting as low back paid in a recreational athlete. Clin J Sport Med. 2002;12(3):184-6.

Mussack T, Schmid bauer S, Norlick A, Schmidt W, Hallfeldt KK. Chronic appendicitis as an independent entity; Chirurg. 2002;73(7):710-5.

Petras R. Non neoplastic Intestinal diseases in stern berg S. Diagnostic surgical pathology, 2nd ed. Philadealphia, Lippincolt Raven. 1966:1359.

Fayez JA, Toy NJ, Flangan TM. The appendix as the cause of chronic lower abdomen paid, Am J Obstet Gynaecol. 1995;172(1 pt 1):122-3.

Harmon KG, Drezner JA, appendicitis in athlete. Clin J Sport Med. 2002;12(3):184-6.

Safaei M, Macinei L, Rasti M. Recurrent abdomen paiin chronic appendicitis. J. Res. Med. Sci. 2004;11-4.

Stamatelous KK, Francis MME, Jones CA. Time trend in reported prevalence of kidney stones in the united states : 1964-1994. Kidney Int. 2003;3:1817-23.

Ueno A, Kawamura T, Ogawa A, Takayasu H. Relation of spontaneous passage of ureteral stones to size. Urology. 1977;10:544-6.

Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain & possible ureteral calculus. Radiology. 2003;228:319-29.

Erwin BC, Carroll BA, Sommer FG. Renal Colic: The role of ultrasound in initial evaluation, Radiology. 1984;152:147-50.

Aslaksen A, Gothlin JH, Ultrasonic diagnosis of ureteral calculus in patient with acute Flank pain. Eur J. Radiol. 1990;11:87-90.

Ripolles T, Agramunt M, Errando J, Martinez MT, Eronel B, Morales M. Suspected uretor colic plain film and sonography vs Unenhanced CT, A prospective study in 66 paitients. Eur Radiol. 2004;14:129-36.

Laing FC, Benson CB, Disalvo DN, Brown DL, Frates MC, Loughlin KR. Distal ureteral calculi: detection with vaginal USG. Radiologyy. 1994;192:545-8.

Park SJ, Yi BH, Lee HK, Kim YH, Kim GJ, Kim HC. Evaluation of patient with suspected ureteral calculi using sonography as an initial diagnostic tool. J. Ultrasound Med. 2008;27:1441-50.

Laing FC, Jeffrey RBJr, Wing WW. Ultrasound versus excretory urography in evaluating acure flank pain. Radiology. 1985;154:613-6.

Al-Araji KS. Recurrent "chronic" appendicitis. Is it a myth? Is appendictomy indicated? Med J. Babylon. 2006;3(1-2):51-5.

Segura JW, Preminger GM, Assimos DG,. Ureteral stones clinical guide lines panel summary report on the management of Urelteral calculi. Jurol. 1997;158:1915-21.

Partis AJ, Sundaram CP. Diagnosis and initial management of kidney stone. American Family Physician 1329. 2001;63(7).

Crabbe MM, Norward SM, Robertson HD, Silva JS. Recurrent and chronic appendicitus. Surg. Gynecol Obstet. 1986;163(1):11-3.

Falk S, Schulze U, Guth H, Stutte JH. Chronic recurrent appendicitus. A clinicopathological study of 47 cases. Eur J Padiatr Surg. 1991;1:277-81.

Zinner M, Ashley S. Laboratory and histopathological evaluation of chronic pain. In main gots text book of abdominal surgery 12th Ed. New York: McGraw Hill Professional. 2012:640.

Hobson T. Acute appendicitis: When is it right to be wrong? Am J Surg. 1964;108:306-12.

Lewis FR, Holcroft JW, Boey J, Dunphy E. appendicitis a critical review of diagnosis and treatment in 1000 cases. Arch Surg. 1975;110:677-84.

Addis DG, Shaffer M, Barbaarw S. The epidemiology of appendix & appendicectomy in the US. Am J Epiodemiol. 1999;132:910-25.

Koep Sell TD, Inue TS, Farewell VT. Factors affecting perforation in Acute Appendicitis. Surg. Gynaecol. Obstet. 1981;153:508-10.

Mueller BA, Daling JR, Mooree DE. Appendicectomy risk of tubal infertility. N Eng J Med. 1986;315:1506-8.

Wolkomir A, Kornak P, Elsakr M. Seasonal variation of acute appendicitis : a 56 year study. Soudh Med J. 1987;80:958-60.

Zinner M, Ashley S. Labratory and histipathological evaluation of chronic pain. Mangots text book of abdominal surgery. 12th ed. New York: McGraw-Hill professional. 2012:640.

Voitk, AJ, Lowry JB. Is incidental appendicectomy a safe procedure? Can J Surg. 1988;31:448-51.