Papers of the Week

The objective of this report is to present a rare case of chronic appendicitis with an atypical presentation. The patient presented with intermittent periumbilical pain without any other symptom, relieved by an anti-inflammatory, and later incidentally diagnosed on computed tomography (CT) scan. The patient was managed with an appendectomy during laparoscopic exploration. A 61-year-old male, with a history of renal calculi, managed type 2 diabetes mellitus, managed hypertension, and ischemic heart disease who underwent percutaneous coronary intervention 10 years ago, presented to the clinic for a CT scan to follow up a non-obstructing renal calculus diagnosed previously. The imaging showed incidental appendiceal findings, and the patient informed the medical team that he had been experiencing intermittent periumbilical pain once every 4-12 weeks for the past year, which was not associated with fever, nausea, or vomiting. At that time, oral non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed, following which his symptoms subsided. A few days later, he presented to the clinic with the same complaint. The patient underwent laparoscopic exploration after numerous clinic visits and was diagnosed with chronic appendicitis. Chronic appendicitis should be explored in afebrile patients with periumbilical pain lasting for several days without other symptoms or predisposing factors. It should also be suspected in patients with recurrent or intermittent vague abdominal pain that subsides with NSAIDs. A CT scan of the abdomen should be conducted, and if the results confirm or imply chronic appendicitis, appendectomy is the preferred therapy.