Clinicopathologic findings in elderly patients with appendix mass

Abstract

Background: An appendix mass is a complication of acute appendicitis with an adherent covering of bowel and omentum enclosing a pocket of pus. A carcinoma may masquerade as an appendix mass in the middle-aged and elderly patients. The clinical findings may not be specific, hence the need for a high index of suspicion when managing the elderly with a suspected appendix mass. Aim: The aim of this study was to highlight the clinicopathological findings in elderly patients with appendix mass. Methods: This is a retrospective study of patients aged 60 and older diagnosed with appendix masses and managed surgically. The study was carried out from January 2002 to December 2005. The hospital records of all patients within the study period were obtained and analyzed. A literature review was done using the PubMed search engine. Data analysis was done using SPSS software version 17. Results: Fifty-eight patients presented with appendix masses and were operated upon during the period with a female:male ratio of 1.5:1. The modal age range was 60-69 years. Most of the patients presented within 5 days of the onset of symptoms. Abdominal pain (89.7%) was the most common symptom. Constitutional symptoms (any of fever, malaise, and anorexia) (27.5%), weight loss (15.5%), and constipation (12.5%) were the other symptoms observed. Acutely inflamed appendix was the most common pathological finding (39.7%). Perforated appendix (17.3%), adenocarcinoma of cecum (15.5%), ameboma (8.6%), benign appendix tumor (5.2%), ascaris-perforated cecum (5.2%), endometriosis (3.4%), and pedunculated fibroid (1.7%) were the other pathological findings. Conclusion: The appendix mass in the elderly should be treated by surgical exploration as soon as the patient is fit because tumors may masquerade in the mass.