Is chronic appendicitis a viable diagnosis? A series of clinical cases

The term "chronic appendicitis" remains a subject of debate and scrutiny in the pediatric community. The diagnosis of "chronic appendicitis" is justified for recurrent pain in the right iliac region, similar to the subacute course of acute appendicitis without clinical and laboratory manifestations of appendix inflammation. This condition can last for months or even years, causing discomfort and reducing quality of life. In such situations, the diagnosis of chronic appendicitis is perceived quite reasonable: the presence of prolonged abdominal pain syndrome (APS) in the right iliac region is implied, with other causes of abdominal pain being ruled out. It is obvious that without clear clinical and instrumental indicators characterizing the concept of "chronic appendicitis", pathophysiological mechanisms of long-term APS development in children, this term can be discredited by unreasonable expansion of indications for appendectomy, as well as poor results of surgical treatment without a reliable guarantee of APS relief in the postoperative period. Thus, the question of the viability and correctness of the diagnosis of chronic appendicitis remains open. The article presents 3 clinical cases with various deviations from the classic clinical presentation of acute appendicitis. A separate line in the practice of pediatric surgeons are considered cases of determining the indications for appendectomy in children with secondary changes in the worm-shaped process, established during surgical interventions for other surgical diseases of the abdominal cavity.