Clinical Evaluation about RLQ Pain Seconary to Chronic Constipation (or Fecal Impaction): About DDx from caute appendicitis

Lee, Sung Chan

Abstract

There are many causes of the right lower quadrant(RLQ) abdominal pain. Although the most common underlying cause may be acute appendicitis, chronic constipation(or fecal impaction) is the cause in some portions. In review of 120 patients with chronic constipation between 1990 and 1996, we evaluated the clinical characteristics of the RLQ pain secondary to chronic constipation. In case of the RLQ pain secondary to chronic constipation, the key points in the DDx from the RLQ pain due to acute appendicitis are as follows. (1) RLQ pain in chronic constipation is characterized by dull pain and usually it has been complained for several weeks, several months or even several years in more than half. (2) The patients don't have accompanying G-I symptoms(such as anorexia, nausea, vomiting, and epigastric pain) in more than 90%. (3) The patient complains of mild tenderness in RLQ area in some cases but no rebound tenderness was found in any cases. (4) In almost all cases, WBC count in patient's blood is within normal limits and body temperature is under 37.0degrees C. (5) For the most part, simple abdomen X-ray finding shows large or moderate amount of fecal material in the colon. So I suggest that (a) DDx in the RLQ pain could be made between acute appendicitis & chronic constipation by above findings and (b) In case of chronic constipation we need not perform negative appendectomy and it could be managed by conservative management such as enema, laxatives, high fiber diet, etc. Conclusively, I mention that the rate of negative appendectomy would be able to be reduced a little by taking these points into consideration in the clinic.