[Chronic appendicitis. Recurrent abdominal pain in the right lower quadrant from the viewpoint of the internist]

There is no clear scientific evidence for a clinically relevant chronic form of appendicitis in the absence of acute flares. Lacking typical symptoms of acute appendicitis or corresponding imaging findings, no indication is given for appendectomy from the internal medicine point of view. By contrast, chronic or recurrent right lower quadrant pain is often of functional origin and may be part of the Irritable Bowel Syndrome or the Functional Abdominal Pain Syndrome. These syndromes are linked to a higher rate of appendectomies in the medical history. The Irritable Bowel Syndrome may be diagnosed based on clinical symptoms alone. But in doubt and in considering malignancy, the indication for diagnostic imaging is given, after ultrasound particularly by colonoscopy. For positively diagnosing these functional syndromes, the typical clinical presentation, extraintestinal pain syndromes, and psychic factors should be evaluated. The visceral hypersensitivity is the predominant pathophysiologic finding and measured by rectal distention stimuli. Medical treatment comprises relaxatives of smooth muscle and low dose antidepressants as modulators of visceral perception. These are supplemented by the psychosocial management.