Abstract
Background: Longer life expectancy has created an increasing demand for surgical care of the elderly. In addition, abdominal surgical emergencies are potentially serious and life threatening for this age group of patients. Aim: The aim of this study is to know the type of common surgical abdominal emergencies, mode of treatment, complications and outcome in elderly patients. Patients and methods: One hundred patients aged 60 years and above who had been admitted to the surgical department in Basrah General Hospital were prospectively evaluated according to the demographic features, causes of abdominal emergencies they presented with, post operative clinical course and outcome. Results: Out of 100 patients included in the study 60% were males and 40% were females, with an average age of 67.39 years (range from 60-83 years). The causes of acute surgical abdominal emergencies were intestinal obstruction (55%), hollow viscus perforation (17%), acute cholecystitis (12%), mesenteric vascular occlusion (9%), and acute appendicitis (7%). Most of the cases of intestinal obstruction were due to adhesion, while perforated DU was the main cause of hollow viscus perforation. Twenty patients (20%) died in the early post operative period with mesenteric vascular occlusion being the leading cause of death (35%). Conclusions: Acute intestinal obstruction and hollow viscus perforation appear to be the main causes of acute abdominal surgical emergencies. Obstructed hernia which constituted 14% of the causes is generally preventable. Acute mesenteric ischaemia and bowel obstruction secondary to colonic tumour had a worse prognosis in elderly patients.
Highlights
Management of surgical illness in geriatric patients is different from that in younger patients and typically more complex
Irreversible bowel ischemia observed in 2 patients of the hernia cases in our study, similar results were reported by Gurleyik et al,[2] who reported that 25% of hernia presented with strangulation and 14% contained gangrenous bowel segment and mortality occurring mainly in elderly patients which is found in our patients
Obstructive malignancy have been reported as an advanced age related pathology in many previous studies. [5,13] This study showed that hollow viscus perforation takes second place in surgical emergencies of older patients, the leading cause was peptic ulcer perforation
Summary
Management of surgical illness in geriatric patients is different from that in younger patients and typically more complex. The major concern of elderly patients is whether or not they will be able to enjoy an independent life after surgery, to at least the extent they did before Such patients may find a radical procedure that offers potential cure less desirable than a more conservative procedure (or endoscopic, percutaneous, or non operative treatment) that relieves pain or other symptoms, largely restores functions, and allows a return to normal surroundings. A thorough knowledge of treatment alternatives and their risks, a close familiarity with natural history of the disease in relation to life expectancy, and a clear understanding of the patient’s goals are paramount in surgical decision making in older persons.[5,6,7] The causes, frequency and consequences of non traumatic abdominal surgical emergencies differ greatly according to patient age. Acute mesenteric ischaemia and bowel obstruction secondary to colonic tumour had a worse prognosis in elderly patients
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