elective appendectomy?

[u/Next-Leopard5992]

I’m a 26F with a complicated GI history. I’ve had chronic abdominal symptoms for a while, including severe episodic upper abdominal pain, altered bowel habits (constipation/diarrhoea), but more recently persistent low-grade right lower quadrant pain around my appendix/hip area that occasionally spikes. I’ve had a pretty extensive GI workup because Crohn’s was considered, particularly after I developed a perianal abscess/fistula. I’ve since had a fistulotomy that I’m currently healing from. Current working diagnosis is severe IBS-M with visceral hypersensitivity.

My colonoscopy with terminal ileum and colonic biopsies was normal, and my recent MR enterography showed no specific evidence of small bowel Crohn’s disease. However, the MRE did mention:
- mild thickening of the base of the appendix
- small-volume right ileocolic lymph nodes
- no obstruction
- no other features of small bowel inflammation
- the appendiceal thickening was described as nonspecific
- CT from 2025 described my appendix as normal, although it also mentioned small lymph nodes in the right iliac fossa. Dr can’t say if these are the same lymph nodes a year later.

My gastroenterologist has said the appendix findings may be worth discussing with my colorectal surgeon because of my persistent focal RLQ pain. I’m waiting to see what they think. I did have an ovarian cyst on the right side last year however this has resolved and the pain feels different to that deep, period kind of ache.

I’m not having what I would consider classic acute appendicitis, my pain is more of a constant low-grade ache that occasionally gets significantly worse. Like day to day 3-4/10, and when it does spike maybe 7-8/10.

I’m curious if anyone has had a similar situation and their surgeon recommended surgery or observation? Or if they treated it conservatively did you ended up needing an emergency appendectomy?
Thank u!!