대한대장항문학회

In case of the RLQ pain secondary to chronic constipation(or fecal impaction), the key<br>points in the differential diagnosis from the RLQ pain due to acute appendicitis are as<br>follows.<br>1 ) Right lower quadrant pain as a chief complaint, is characterized by dull pain and<br>has been complained by patients for several weeks, several months, or several years in<br>many cases.<br>2) There is almost no G-I symptoms(such as anorexia, nausea, vomiting, diarrhea or<br>epigastric pain) accompanied with the RLQ pain, except constipation.<br>3) The patient complains mild tenderness in RLQ area in some cases and no rebound<br>tenderness in all cases.<br>4) In almost all cases, WBC count in patient's blood is within normal limits and body<br>temperature is under 37.0℃.<br>5) For the most part, simple abdomen X-ray finding shows large or moderate amount<br>of fecal material in the ascending, descending, and transverse colon.<br>And we should notice that the therapeutic method in patients with RLQ pain<br>secondary to chronic constipation(or fecal impaction) is not appendectomy, but the<br>conservative management such as enema, laxative, or high fiber diet therapy.<br>So I suggest that(1) we can differential-diagnose chronic constipation(or fecal<br>impaction) from acute appendicitis through careful history taking, physical examination<br>and laboratory findings and(2) in case of chronic constipation(or fecal impaction) we<br>need not perform appendectomy unnecessarily, but we should plan<br>conservative<br>management about chronic constipation.<br>