Appendiceal Colic
What is appendiceal colic?
Appendiceal colic is the most frequent cause of chronic appendix pain. It is caused by contractions or spasms of the appendix, a hollow muscular tube located in the lower right abdominal area. The term "colic" refers to the severe, cramping abdominal pain associated with the spasms. The gallbladder, urinary tubes, gastrointestinal tract and female organs (uterus and fallopian tubes) are also hollow muscular tubes.
When these tubes become blocked, the muscle surrounding the hollow center (lumen) vigorously tries to pass the obstruction, resulting in appendiceal colic.
How does appendiceal colic differ from acute appendicitis?
With acute appendicitis, the appendix becomes inflamed or there is complete obstruction of the lumen. The increasing pressure causes the appendix to die. With appendiceal colic, the obstruction is usually partial, or it may come and go. As the obstruction increases, pain increases. As the obstruction decreases, pain decreases. Unlike a patient with acute appendicitis, a patient with appendiceal colic may experience relief of symptoms.
A patient with appendiceal colic may squirm and cry with pain, but a patient with acute appendicitis prefers to lie still since inflammation and infection in the appendix makes movement of any kind painful.
What causes appendiceal colic?
A number of things may cause the blockage that results in appendiceal colic, including:
- Plugs of stool may be pushed into the large bowel, giving relief of pain that may later reoccur
- Scar tissue (fibrosis)
- Foreign matter (seeds)
- Tumors
In addition, lymph tissue in the wall of the appendix may expand in response to viral infections in the upper respiratory and gastrointestinal tracts, thereby blocking the lumen. As the obstruction increases, the pain increases. As lymph tissue goes back to a more normal size, pain is likely to disappear.
What are the signs and symptoms of appendiceal colic?
- Cramps that come and go -- when the pain is very severe, the patient may become pale and sweaty, indicating that the pain is "real"
- Sunken or glassy eyes or darkening below the eyes
- Headaches or lightheadedness
- Soft, loose bowel movements (not watery diarrhea) at time of painful episodes
On rare occasions, the patient may become flushed and complain of a hot flash.
How is appendiceal colic diagnosed?
Establishing the diagnosis of appendiceal colic is often quite difficult. An extensive diagnostic work-up may not be able to determine the cause of the pain. A careful physical examination and thorough medical history are essential.
Since the appendix is part of the gastrointestinal (GI) tract, anything that stimulates activity and movement of the GI tract may stimulate the contraction of the appendix and cause appendiceal colic. The association of the rapid onset or worsening of pain with eating is a key diagnostic factor. Pain usually occurs within five to 15 minutes after eating, regardless of the type of food (or drink) that is eaten. Although this association is not always present with every episode, it can occur frequently enough to be a helpful diagnostic factor for both parents and physicians.
As a result of the association between eating and the rapid onset of pain, the patient may experience "food fear," and avoid eating. Weight loss may be significant, sometimes as much as 15 to 20 pounds.
Are routine laboratory and radiologic studies helpful in establishing the diagnosis?
Abdominal X-ray will occasionally indicate a calcified stool ball in the appendix, suggesting the diagnosis. Also, an upper and lower GI series with delayed films are sometimes useful. Since infection is rare with appendiceal colic, radiologic studies such as ultrasound, computed tomography (CT scan) and magnetic resonance imaging (MRI), which are used to detect infection in acute appendicitis, usually yield no useful findings.
What is the best time to have my child evaluated by a physician?
When pressure is placed on the abdomen over a cramping appendix, the intensity of the pain will increase. Because of this, it is essential that the patient be examined during an acute painful episode.
If the child is not in pain when the abdomen is examined, the examination will usually yield no remarkable diagnostic findings. Since eating may trigger pain, it may be worthwhile to try feeding your child to ensure an accurate physical examination.
How is appendiceal colic treated?
Once the diagnosis is made with certainty, an elective appendectomy is performed.
In 90-95% of patients, this operation results in the complete disappearance of pain.
What are the consequences of not being correctly diagnosed?
- A child may eventually develop acute appendicitis
- Pain may continue for months or even years, causing increased school absenteeism, falling grades, a decline in participation in sports and social activities, and extreme weight loss
- With physicians unable to establish a definite diagnosis despite an extensive diagnostic work-up, and with parents then doubting the reality of the pain, a child may become tired and show a lack of energy.
Rev. 6/06
