Chapter 9 - Abdominal Emergencies in Geriatric Patients

Abstract

The investigation of the acute abdomen in elderly patients poses several unique challenges, including atypical clinical presentations, delays in seeking medical care, other coexistent diseases, and specific requirements for scanning and contrast protocols in order to optimize image quality. This chapter begins by examining the ways in which computed tomography (CT) and magnetic resonance imaging protocols should be adjusted for geriatric patients, along with considerations for adjusting contrast injection techniques. Clinical considerations by organ system are then addressed, focusing on diseases that are particularly important or more likely to occur in this age group, as well as normal changes in the appearance of the abdomen with age. Key conditions of the gastrointestinal tract in this population that are discussed include peptic ulcer disease, colonic volvulus, stercoral colitis, gallstone ileus, and acute mesenteric ischemia. Hepatobiliary conditions including congestive hepatopathy, emphysematous and acalculous cholecystitis, and gallstone ileus are addressed, as well as differentiating gallbladder carcinoma from perforated cholecystitis. Signs of an occult pancreatic malignancy are reviewed, as are the findings of atypical and emphysematous infections of the genitourinary system. Aortic aneurysms are much more common in these patients, and signs of impending rupture are presented. Finally, the chapter concludes with a review of intraabdominal complications of medications elderly patients may be taking that can present on abdominal CT.