A Rare Presentation of Chronic Appendicitis in the Right Upper Quadrant: A Case Report

Chronic appendicitis is a rare cause of chronic abdominal pain that can be difficult to diagnose. We present a patient with chronic right upper quadrant pain that was finally diagnosed as chronic appendicitis. This 71year-old male had no systemic diseases and presented to our outpatient clinic with right upper quadrant pain for one month. The pain tended to worsen in the early morning but could be relieved by bowel movements, sitting up, or walking. The findings of a physical examination, laboratory data, and abdominal ultrasound were not significant. Upper endoscopy revealed a shallow gastric ulcer at the antrum. However, the abdominal pain was not relieved by esomeprazole. A computed tomography (CT) scan revealed a dilated appendix with some appendicoliths in the retrocecal region. Due to chronic appendicitis, the patient underwent laparoscopic appendectomy, and the histopathological examination of the removed appendix confirmed the diagnosis. The abdominal pain completely resolved after the surgery. Chronic appendicitis should be kept in mind in patients with chronic abdominal pain without a definite diagnosis. This case illustrates that in addition to right lower quadrant pain, chronic appendicitis can also present with right upper quadrant pain or vague abdominal pain. A CT scan is invaluable in the diagnosis of abdominal pain when medical treatment fails to yield improvement.