BARIUM ENEMA AND CHRONIC APPENDICITIS

<p>Chronic appendicitis presents inflammation of appendix with atypical clinical findings, without significant signs<br />and symptoms. Because of that diagnosing chronic appendicitis presumes a great problem. Indications for operative treatment based on clinical impression are followed with a great number of unnecessary appendectomies. Barium enema can show morphlogic changes of appendix during its chronic inflammation. Our aim was to show values of barium enema in diagnosing chronic appendicitis. Study went prospectively, in period 1999-2001 on Clinic for abdominal and endocrine<br />surgery, Institute for surgery Novi Sad. It includes 100 patients with symptoms, 50 of them were operated after barium<br />enema, and other 50 were operated after clinical impression of surgeon. Each appendix was patohistologicaly examined.<br />Incidental appendectoies were exluded. Of total 1425 appendectomies in three years period, 100 were operatde because of chronic appendicitis. Fifty of them were operated after barium enema, and other 50 were operated after clinical impression of surgeon. Range of years was 15 59 in examined group with average 35,6 years. In control group range was 15 57, with average 32,9 years. Lasting of pain episode more than 12 hours had 94% of patients in examined group, and 72% of patients in control group had painn less than 24 hourrs. During of pain episodes at 92% of patients from examined group was 3 weeks to 12 months, and 86% of patients from control group had pain standing 3-36 weeks. The most common sign on barium enema was finding of coprolites in lumen (52%), followed with unfilled appendix (18%, angulations (10%), distal amputation (8%), segmentation of contrast (8%), and fixated appendix (4%). Intraoperative macroscopic findings were as followed: 40/50 coprolites in lumen, 7/50 fibrous bounds, and 3/50 fibroses of appendix. Patohistologicaly, chronic appendicitis was confirmed at 90% of patients in examined group, and 58% in control group. After surgery, 94% of patients from examined group don't feel the preoperative pain. Barium enema significantly increases of chronic appendicitis. It is non-invasive, and reliable method for showing morphologic changes of chronic appendix. Use of barium enema dereases number of unnecessary appendectomies. Barium enema is suggested for evaluation of patients with chronic pain in right lower quadrant of abdomen, and thereby for diagnosing of chronic appendicitis. </p>