Chronic appendicitis is a long-standing, low-grade inflammation of the appendix that may smoulder for weeks or months. Because its signals are often subtle and intermittent, it is easily missed or misdiagnosed as irritable-bowel syndrome, gastroenteritis, or gynaecological pain. Key manifestations include:
- Dull, intermittent right-lower-quadrant pain
Discomfort usually starts near the umbilicus and drifts to McBurney’s point, lasting minutes to hours, then remits for days or weeks. Episodes may be triggered by brisk walking, coughing, or a heavy meal. - Low-grade fever or evening temperature rise
Temperature seldom exceeds 38 °C; many patients simply feel “warm” or notice night sweats. - Nausea, bloating, and early satiety
Mild queasiness, a swollen abdomen, or the sense of fullness after a few bites are common; vomiting is rare. - Bowel irregularity
Alternating loose stools and constipation may accompany each flare, leading to a mislabel of “functional bowel”. - Localised tenderness on palpation
Gentle pressure over the right iliac fossa reproduces pain even between attacks; rebound tenderness is usually absent. - Fatigue and malaise
A vague washed-out feeling or difficulty concentrating often persists after pain subsides. - Acute exacerbation
Months of minor complaints may suddenly culminate in classic acute appendicitis with severe pain, high fever, and raised inflammatory markers, sometimes ending in perforation.
Because symptoms wax and wane, any recurrent right-sided abdominal discomfort lasting more than four to six weeks, especially when paired with low-grade fever or localised tenderness, merits imaging (graded-compression ultrasound or MRI) and surgical consultation.
| Symptom | Typical Pattern | Helpful Clues |
|---|---|---|
| Pain | Intermittent, dull, RLQ | Remits spontaneously, recurs weeks later |
| Fever | ≤38 °C, evening rise | Normal WCC between flares early on |
| GI upset | Bloating, mild nausea | Vomiting unusual |
| Bowel habit | Looseness or constipation | Alternating pattern |
| Palpation | Localised tenderness | Rebound/guarding absent |
| Complication | Sudden severe attack | Suggests progression to acute appendicitis |