bodyType

customContents

entityId

printArticlePageQuery

filter

article

body

urlAlias

articleSectionsContent

articleSeoArticle

articleSourceHeaderArticle

contentSchemaRenderContent

contentSubHeadlineContent

contentHeadlineContent

mainImagePrintArticleArticle

authorBlockPrintArticleArticle

contentSponsorTagContent

articlePianoPaywallContent

scmpYoutubeContent

hooksTrackPageViewArticle

query printArticlePageQuery(
  $entityId: String!
  $customContents: [CustomContentInput]
  $bodyType: BodyFormatTypeEnum
) {
  article(filter: {entityId: $entityId}) {
    entityId
    body(customContents: $customContents, type: $bodyType) {
      json
    }
    urlAlias
    ...articleSectionsContent
    ...articleSeoArticle_3o8td4
    ...articleSourceHeaderArticle
    ...contentSchemaRenderContent
    ...contentSubHeadlineContent
    ...contentHeadlineContent
    ...mainImagePrintArticleArticle
    ...authorBlockPrintArticleArticle
    ...contentSponsorTagContent
    ...articlePianoPaywallContent
    ...scmpYoutubeContent
    ...hooksTrackPageViewArticle
    id
  }
}

fragment articlePianoPaywallContent on Content {
  __isContent: __typename
  ...hooksPaywallPromiseContent
}

fragment articleSectionsContent on Content {
  __isContent: __typename
  sections {
    value {
      ...helpersCheckIfNewsSectionInFirstIndexSection
      ...entityLink
      name
      id
    }
  }
}

fragment articleSeoArticle_3o8td4 on Article {
  ...hooksArticleSeoArticle
  ...helpersCheckIsPostiesArticle
  ...helpersGetArticleTypeArticle
  entityId
  publishedDate
  updatedDate
  summary {
    text
  }
  subHeadline {
    text
  }
  body(customContents: $customContents, type: $bodyType) {
    text
  }
  keywords
  sections {
    value {
      name
      id
    }
  }
  topics {
    name
    entityId
    id
  }
  urlAlias
  authors {
    name
    id
  }
  images {
    style(filter: {style: "768x768"}) {
      url
    }
  }
  readingTime
}

fragment articleSourceHeaderArticle on Article {
  urlAlias
  ...entityLink
}

fragment authorBlockPrintArticleArticle on Article {
  ...defaultArticleDateContent
  ...authorNamesArticle
}

fragment authorNameAuthor on Author {
  ...entityLink
  name
  entityUuid
}

fragment authorNamesArticle on Article {
  authorLocations
  authors {
    entityId
    location
    ...authorNameAuthor
    id
  }
}

fragment blockquoteQuoteContent on Content {
  __isContent: __typename
  ...contentShareWidgetContent
}

fragment checkersCheckContentContainsStarlingImageContent on Content {
  __isContent: __typename
  topics {
    entityId
    id
  }
}

fragment contentHeadlineContent on Content {
  __isContent: __typename
  headline
  socialHeadline
  ...contentHeadlineTagContent
  ...helpersUseContentSponsorContent
}

fragment contentHeadlineTagContent on Content {
  __isContent: __typename
  ...hooksContentHeadlineTagContent
}

fragment contentNewsletterWidgetContent on Content {
  __isContent: __typename
  topics {
    relatedNewsletters {
      ...helpersMassageToNewsletterItemNewsletter
      id
    }
    id
  }
  sections {
    value {
      relatedNewsletters {
        ...helpersMassageToNewsletterItemNewsletter
        id
      }
      id
    }
  }
  ... on Article {
    relatedNewsletters {
      ...helpersMassageToNewsletterItemNewsletter
      id
    }
  }
}

fragment contentSchemaRenderContent on Content {
  __isContent: __typename
  ...blockquoteQuoteContent
  ...imageContent
  ...inlineWidgetContent
  ...photoGalleryWidgetContent
  ...scmpYoutubeContent
}

fragment contentShareWidgetContent on Content {
  __isContent: __typename
  entityId
  urlAlias
  shortUrl
  socialHeadline
  headline
}

fragment contentSponsorTagContent on Content {
  __isContent: __typename
  ...helpersUseContentSponsorContent
}

fragment contentSubHeadlineContent on Content {
  __isContent: __typename
  subHeadline {
    json
  }
  summary {
    json
  }
  ...contentSchemaRenderContent
}

fragment defaultArticleDateContent on Content {
  __isContent: __typename
  ...hooksArticleDateUtilsContent
}

fragment entityLink on BaseWithApplicationAndUrlAlias {
  __isBaseWithApplicationAndUrlAlias: __typename
  __typename
  entityId
  entityUuid
  urlAlias
  urlRedirect {
    toUrl
    id
  }
  application {
    entityId
    id
  }
  ... on Section {
    fullSectionPath {
      entityId
      id
    }
    parentSection
  }
  ...helpersAppBarVariantBase
  ...helpersApplicationBase
  ...helpersCheckIsPlusArticle
  ...helpersStyleSectionContent
}

fragment helpersAppBarVariantBase on BaseWithApplicationAndUrlAlias {
  __isBaseWithApplicationAndUrlAlias: __typename
  ...helpersCheckIsLiveArticle
  ...helpersCheckIsPlusPage
  ...helpersCheckIsPostiesArticle
  ...helpersCheckIsPostiesPage
  ...helpersCheckIsPostMagazineArticle
  ...helpersCheckIsStyleArticle
  ...helpersSectionContent
  ...helpersStyleSectionContent
}

fragment helpersApplicationBase on BaseWithApplicationAndUrlAlias {
  __isBaseWithApplicationAndUrlAlias: __typename
  ...helpersCheckIsPostiesArticle
  ...helpersCheckIsPostiesPage
  ...helpersCheckIsPlusPage
}

fragment helpersCheckIfNewsSectionInFirstIndexSection on Section {
  name
}

fragment helpersCheckIsAmpEnabledArticle on Article {
  entityId
  types {
    value {
      entityId
      id
    }
  }
  sections {
    value {
      entityId
      id
    }
  }
  disableOffPlatformContent
  sponsorType
  published
  ...helpersCheckIsPlusArticle
  ...helpersCheckIsPostiesArticle
}

fragment helpersCheckIsLiveArticle on Article {
  flattenTypeIds
  liveArticle {
    status
    id
  }
}

fragment helpersCheckIsMainTopicContent on Content {
  __isContent: __typename
  topics {
    entityId
    id
  }
}

fragment helpersCheckIsPlusArticle on Content {
  __isContent: __typename
  ... on Article {
    paywallTypes {
      entityUuid
      id
    }
  }
}

fragment helpersCheckIsPlusPage on Page {
  urlAlias
}

fragment helpersCheckIsPostMagazineArticle on Article {
  sections {
    value {
      entityId
      id
    }
  }
}

fragment helpersCheckIsPostiesArticle on Article {
  sections {
    value {
      entityId
      id
    }
  }
}

fragment helpersCheckIsPostiesPage on Page {
  urlAlias
}

fragment helpersCheckIsStyleArticle on Content {
  __isContent: __typename
  sections {
    value {
      entityId
      id
    }
  }
}

fragment helpersGetArticleTypeArticle on Content {
  __isContent: __typename
  ... on Article {
    types {
      value {
        entityId
        id
      }
    }
  }
}

fragment helpersMassageToNewsletterItemNewsletter on Newsletter {
  entityId
  name
  alternativeName
  description {
    text
  }
  summary {
    text
  }
  homepageDescription {
    text
  }
}

fragment helpersSanitizeArticleTypeEntityIdsArticle on Article {
  types {
    value {
      entityId
      id
    }
  }
}

fragment helpersSanitizeAuthorTypesArticle on Article {
  authors {
    types
    id
  }
}

fragment helpersSanitizedAuthorEntityIdsArticle on Article {
  authors {
    entityId
    id
  }
}

fragment helpersSectionContent on Section {
  fullSectionPath {
    entityId
    id
  }
}

fragment helpersStyleSectionContent on Section {
  fullSectionPath {
    entityId
    id
  }
}

fragment helpersUseContentSponsorContent on Content {
  __isContent: __typename
  topics {
    entityId
    sponsor {
      ...sponsorTagSponsor
      name
      type
      id
    }
    id
  }
  ... on Article {
    sponsorType
  }
  ...helpersCheckIsMainTopicContent
}

fragment hooksArticleDateUtilsContent on Content {
  __isContent: __typename
  createdDate
  publishedDate
  updatedDate
}

fragment hooksArticleSeoArticle on Article {
  ...helpersCheckIsPostiesArticle
  ...helpersCheckIsPostMagazineArticle
  ...helpersCheckIsStyleArticle
  ...hooksContentHeadlineTagContent
  ...helpersCheckIsAmpEnabledArticle
  entityId
  headline
  socialHeadline
  types {
    value {
      entityId
      id
    }
  }
  authors {
    entityId
    id
  }
  images {
    generic_og: style(filter: {style: "og_image_scmp_generic"}) {
      url
    }
    styles(filter: {styles: ["og_image_posties_article", "og_postmag", "og_image_style", "og_image_scmp_analysis", "og_image_scmp_explainer", "og_image_scmp_editorial", "og_image_scmp_fact_check", "og_image_scmp_debate", "og_image_scmp_live", "og_image_scmp_obituary", "og_image_scmp_opinion", "og_image_scmp_review", "og_image_scmp_series", "og_image_scmp_generic"]}) {
      url
      style
    }
    type
  }
  urlAlias
}

fragment hooksContentHeadlineTagContent on Content {
  __isContent: __typename
  __typename
  ... on Article {
    types {
      value {
        name
        entityId
        description {
          text
        }
        id
      }
    }
    ...helpersCheckIsStyleArticle
  }
  flag
  sections {
    value {
      name
      id
    }
  }
  ...hooksContentHelperContent
}

fragment hooksContentHelperContent on Content {
  __isContent: __typename
  ...helpersSanitizeArticleTypeEntityIdsArticle
  ...helpersSanitizeAuthorTypesArticle
  ...helpersSanitizedAuthorEntityIdsArticle
  flag
}

fragment hooksPaywallPromiseContent on Content {
  __isContent: __typename
  entityId
  ...helpersCheckIsPostiesArticle
}

fragment hooksTrackPageViewArticle on Article {
  entityId
  publishedDate
  headline
  sections {
    value {
      name
      id
    }
  }
  urlAlias
  authors {
    name
    id
  }
  entityUuid
}

fragment imageContent on Content {
  __isContent: __typename
  headline
  ...checkersCheckContentContainsStarlingImageContent
}

fragment inlineWidgetContent on Content {
  __isContent: __typename
  ...contentNewsletterWidgetContent
}

fragment mainImagePrintArticleArticle on Article {
  images {
    title
    url
    isSlideshow
    size_652x446: style(filter: {style: "652x446"}) {
      url
    }
  }
}

fragment photoGalleryDialogContent on Content {
  __isContent: __typename
  __typename
  ...contentShareWidgetContent
}

fragment photoGalleryWidgetContent on Content {
  __isContent: __typename
  ...photoGalleryDialogContent
}

fragment scmpYoutubeContent on Content {
  __isContent: __typename
  entityId
  urlAlias
  publishedDate
}

fragment sponsorTagSponsor on Sponsor {
  name
  type
  images {
    url
  }
}


sections

types

disableOffPlatformContent

sponsorType

published

headline

socialHeadline

authors

images

publishedDate

updatedDate

summary

subHeadline

keywords

topics

readingTime

authorLocations

entityUuid

Elizabeth Svoboda

The pain first hit when I was a teenager: an unrelenting grinding in my lower abdomen, as if my internal gears were gummed up. A fleeting thought crossed my mind – could it be my appendix? – but I dismissed it, since I felt fine the next day.
Throughout my young adulthood, the grinding pain recurred every few weeks or so. When it hit, I’d clench my jaw and curl up in the fetal position, but within a few hours, the attack would pass. I wasn’t concerned enough to have a doctor check me out since things receded quickly.
But then in my early 30s, I had what seemed like just another bout of this pain, but this time, it didn’t go away. I headed to the hospital, where I learned that my appendix was about to rupture.
The appendectomy performed on me revealed the likely origins of the mysterious pain that had plagued me for more than half my life. Appendicitis, it turns out, isn’t always acute. Some people can limp along for years with appendix-related pain from some sort of inflammation or obstruction – a condition known as chronic appendicitis.

Debate has long raged among physicians about whether the condition dubbed “grumbling appendix” is real.
“Chronic appendicitis can be controversial and is often misdiagnosed,” writes radiologist David Kim of the University of Wisconsin at Madison.

Specialists used to consider chronic appendicitis “like the Monster of Loch Ness – something that was out there, but no one had seen it properly,” says Ran Goldman, a paediatric emergency doctor at the University of British Columbia and the BC Children’s Hospital, who has co-written a study on chronic appendicitis in children.
But while controversy about the diagnosis still simmers, the consensus has moved somewhat toward acceptance of chronic appendicitis as a medical phenomenon.
In the community of gastrointestinal experts, “People are recognising more and more that there is an entity like this,” Goldman says.
A case report last year in Annals of Medicine and Surgery describes a patient whose 18 years of symptoms resolved as soon as his appendix was taken out. And a 2015 paper argues that clinical cases from the past two decades support the theory that chronic appendicitis, while rare, does exist.
Eight useless body parts – sinuses, tonsils, appendix among them – that human evolution has left behind
Part of the mystery stems from how difficult it is to diagnose.
The signs of acute appendicitis are fairly clear-cut: pain in the lower right part of the abdomen, loss of appetite and low-grade fever.
But with chronic appendicitis, not all of these symptoms may be present, and even when they are, they may clear up for a while. A white blood cell count, often elevated in acute appendicitis, may come back normal.
What’s more, symptoms of chronic appendicitis can overlap with signs of more common gastrointestinal conditions, such as irritable bowel syndrome (IBS), Crohn’s disease or even cancer.
(I assumed for years that I had IBS, which causes abdominal pain and diarrhoea, though the label didn’t quite fit; I never needed Imodium.)

To arrive at a possible diagnosis of chronic appendicitis, clinicians first need to take a detailed history, says Jennifer Goldstein, an internist at Pennsylvania State University’s Milton S. Hershey Medical Centre. Recurrent, intermittent pain in the area of the appendix might tip her off – “a patient who’s saying, ‘Why does this keep happening? I don’t have an answer.’ ” The pain might last for a few hours or days and then go away.
But a medical history by itself is not enough, Goldstein says. In recent years, specialists have relied on high-resolution imaging technologies such as ultrasound and computed tomography (CAT) scans to detect the often subtle signs of chronic appendicitis when a history and physical exam yield no clear answers.
“Imaging probably should be done on patients that have recurrent abdominal pain,” Goldman says. Ultrasound, he added, is a good first step because it is less invasive than a CAT scan, which uses radiation.
Do we need an appendix? Why it could be useful, how to know if yours is inflamed, and history of the ‘useless’ organ
Since chronic appendicitis is so rare, most imaging studies of people with abdominal pain will show a normal appendix – not the inflammation or blockage often seen in acute appendicitis. Certain findings do suggest ongoing issues with the appendix – a thickening of the organ’s wall, for instance, or a cyst on the appendix that is filled with mucus.
If I’d had an ultrasound or CAT scan done when I was a teen, notes University of Manchester gastroenterologist Peter Whorwell, it’s possible doctors might have seen one of those things and would have picked up on my appendix issue much earlier.
When doctors suspect chronic appendicitis, they face a difficult decision: Should they wait and see whether the pain clears up on its own – or should they go forward with an appendectomy, even though the situation is not yet life-threatening? Specialists say their judgment depends on the specifics of a given case. Sometimes, doctors may prescribe antibiotics to avoid having to perform surgery, which always carries risk. But follow-up exams are crucial in any case.

“Some cases resolve,” Goldman says. “Others become so acute that there is no question the patient needs to go to the operating room.” An inflamed appendix that bursts can be life-threatening because it ejects bacteria into the abdomen, spreading infection.
Clear signs of infection or swelling on a CAT scan, along with significant ongoing pain, may convince doctors to go ahead with surgery.
“An appendectomy is a tried and true operation,” says gastroenterologist Seth Crockett of the University of North Carolina at Chapel Hill and a spokesman for the American Gastroenterological Association. “Most surgeons are comfortable doing it, and it’s been around forever.”
Doctor botches appendicitis surgery and leaves removed gut in patient’s body
Still, few doctors choose this option lightly.
“The default approach is, if an appendix is inflamed, you take it out,” Whorwell says. But some of his patients have had serious post-operative pain after having abdominal organs removed – especially patients with IBS, who often have high pain sensitivity. So Whorwell opts for a conservative approach, advising patients not to have an appendectomy unless there’s a compelling reason for it. He may re-evaluate later on if their pain persists or gets worse. If Whorwell had seen me as a teenager and my scans showed nothing definite, he says, “I’d have told you to hold on to your appendix.”

At the time, I probably would have agreed with him. The pain bothered me only for a few days a month at most. Besides, I didn’t even know for sure whether my appendix was the cause.
But in the end, I’m glad my symptoms progressed enough to land me in the accident and emergency department. After I had my appendectomy, I was gobsmacked and overjoyed to find my recurrent pain was gone for good, nearly 20 years after it began.
The Washington Post


Why you need to listen to your grumbling appendix, even after years of putting up with it

Do you have a grumbling appendix? If you do, it might be a good idea to see a doctor. Photo: Alamy

David Kim of the University of Wisconsin at Madison.Photo: HANDOUT[FEATURES 2019]

Jennifer Goldstein, an internist at Pennsylvania State Universityâs Milton S. Hershey Medical Centre.Photo: HANDOUT[FEATURES 2019]

HGNYR6 APPENDICITIS, DRAWING

Ran Goldman, a pediatric emergency physician at the University of British Columbia and the BC ChildrenÕs Hospital.Photo: HANDOUT[FEATURES 2019]

PEY8HX Appendicitis. Illustration of a human appendix, showing it red and inflamed in appendicitis and a close-up view of bacteria, the causative agents of appendicitis. The most common microorganisms recovered from appendix with acute appendicitis are Escherichia coli and Bacteroides sp., the less commonly found are, Klebsiella pneumoniae, Streptococcus sp. Enterococcus sp. Pseudomonas aeruginosa and other bacteria.

Lifestyle

Health & Wellness

Health

If you have endured bouts of abdominal pain over the years, you may suffer from what some doctors call chronic appendicitis
Because of a lack of classic symptoms, medical opinion is divided on whether it exists, and how it should be treated


If you have endured bouts of abdominal pain over the years, you may suffer from what some doctors call chronic appendicitis. Because of a lack of classic symptoms, medical opinion is divided on whether it exists, and how it should be treated.


Wellness

Medicine

Why you need to listen to your grumbling appendix, even after years of putting up with it

If you have endured bouts of abdominal pain over the years, you may suffer from what some doctors call chronic appendicitis Because of a lack of classic symptoms, medical opinion is divided on whether it exists, and how it should be treated

If you have endured bouts of abdominal pain over the years, you may suffer from what some doctors call chronic appendicitis

Because of a lack of classic symptoms, medical opinion is divided on whether it exists, and how it should be treated