Which is more serious, acute appendicitis or chronic appendicitis?

Written by Ren Zheng Xin
Gastroenterology
Updated on March 06, 2025
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Acute appendicitis is relatively common in clinical practice with severe symptoms. Compared to chronic appendicitis, acute appendicitis can cause the appendix tube to become purulent and perforate, leading to a widespread peritonitis. Severe peritonitis can cause multi-organ failure and even shock. Chronic appendicitis, on the other hand, mainly manifests as chronic abdominal pain and seldom shows signs of appendix perforation. It primarily leads to an abscess around the appendix, encapsulating the appendix and causing repetitive chronic pain, which is difficult to heal. Both acute and chronic appendicitis should be treated surgically by removing the appendix to achieve a complete cure.

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Written by Ren Zheng Xin
Gastroenterology
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Does acute appendicitis hurt?

Acute appendicitis is associated with abdominal pain, the severity of which is directly related to the extent of the inflammation. If the inflammation is mild, the abdominal pain can be tolerable. However, if there is significant pus in the appendix or perforation, it can cause severe abdominal pain, similar to being cut by a knife. Acute appendicitis generally requires surgical treatment. Currently, a common procedure is laparoscopic appendectomy, which causes less bleeding during surgery and allows for a quicker recovery with minimal damage to the body. For patients who cannot tolerate general anesthesia, spinal anesthesia can be used, and the appendix can be removed through an incision at McBurney's point.

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Written by Ren Zheng Xin
Gastroenterology
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Acute Appendicitis Etiology

The cause of acute appendicitis is primarily bacterial infection of the appendiceal lumen due to various reasons. The appendix itself is a narrow tube connected to the cecum. If a fecalith falls into the lumen, it can cause obstruction of the appendiceal lumen, leading to an increase in intra-luminal pressure and circulatory disturbances in the appendiceal wall. At this time, the mucosa is susceptible to damage, and bacterial invasion of the wall can cause infections of varying degrees. Additionally, gastrointestinal dysfunction, such as diarrhea or constipation, can also cause spasms of the appendiceal vessels, leading to blood supply disturbances and resulting in acute inflammation.

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Written by Ren Zheng Xin
Gastroenterology
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The cause of acute appendicitis

The etiology of acute appendicitis is directly related to obstruction and infection of the appendiceal lumen. The appendix, a narrow and elongated tube connected to the cecum, can develop increased luminal pressure due to obstruction, leading to disturbances in the blood supply to the appendiceal wall. This can easily cause damage to the mucosa and subsequent infection. Infection of the appendiceal lumen can directly cause acute appendicitis. Additionally, gastrointestinal dysfunction can also cause muscle and vascular spasms in the appendix leading to blood supply disturbances and the invasion of bacteria, resulting in acute inflammation. For acute appendicitis, surgical treatment should be administered immediately upon diagnosis.

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Written by Ren Zheng Xin
Gastroenterology
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The Difference Between Acute and Chronic Appendicitis

The differences between acute appendicitis and chronic appendicitis mainly lie in the onset of the condition, physical signs, and laboratory tests. First, regarding the onset of the condition, acute appendicitis occurs suddenly and can involve abrupt abdominal pain, whereas chronic appendicitis often manifests as fixed tenderness in the lower right abdomen and the symptoms are not particularly typical. In terms of physical signs, acute appendicitis presents with migratory pain in the lower right abdomen, while chronic appendicitis generally does not involve rebound pain. Thirdly, concerning auxiliary examinations, acute appendicitis shows a significant increase in the white blood cell count during an attack, whereas in chronic appendicitis, the white blood cell count may appear normal.

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Written by Ren Zheng Xin
Gastroenterology
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Symptoms of acute appendicitis

The typical symptoms of acute appendicitis include abdominal pain that starts around the upper abdomen or navel area, then localizes to the lower right abdomen. There are also manifestations of gastrointestinal spasms such as nausea and vomiting. Due to inflammation entering the bloodstream, there can be a systemic infection, often accompanied by fever, generally not exceeding 38 degrees Celsius. If there is an appendix perforation and peritonitis, the temperature can exceed 38 degrees. After the appendix becomes suppurative, symptoms can include abdominal muscle rigidity, dental pain, and rebound tenderness.