Acute Appendicitis In Elderly Patients Research Articles

An unusual case of appendicitis

Acute appendicitis in elderly patients often presents late and atypically. Presentation as an incarcerated femoral hernia is rare. To describe the management of an elderly patient presenting with acute appendicitis in an incarcerated femoral hernia. The femoral canal was explored and the hernia repaired. Formal appendicectomy was performed via a midline laparotomy incision. Histological examination confirmed the diagnosis of acute appendicitis. Unusual clinical presentations of acute appendicitis represent an interesting diagnostic challenge.

Clinical and laboratory findings in acute appendicitis in the elderly.

Early diagnosis and surgery are important factors by which the morbidity and mortality of acute appendicitis in elderly patients can be lowered. This study was conducted to determine clinical and laboratory results that are commonly associated with acute appendicitis in elderly patients. A retrospective chart review was conducted of patients aged 60 years or older who underwent appendectomy or laparotomy for suspected acute appendicitis during a 5-year period in a metropolitan county. Acute appendicitis was confirmed by the pathology report. Elevated band cells and right lower quadrant pain were predictors of acute appendicitis in clinically suspected cases. Band cells greater than 6 percent had an excellent positive predictive value, as all patients with elevated band cells had acute appendicitis. With increasing white cell count and temperature, specificity increased, sensitivity decreased, and the positive predictive value remained high. It is essential to have a high degree of suspicion to recognize acute appendicitis in an afebrile elderly patient who has abdominal pain, a mildly elevated white cell count, and band cells in the upper limits of normal.

ACUTE APPENDICITIS IN THE ELDERLY: A 5-YEAR RETROSPECTIVE STUDY

Acute appendicitis in elderly patients has not been studied extensively in the United Kingdom. Studies were performed prior to the regular use of broad spectrum antibiotics and tended to include younger patients. We studied retrospectively all elderly patients (n = 30, mean age = 72 years) who presented in the years 1980-85 and a younger group (n = 30, mean age = 23 years) who had a confirmed pathological diagnosis of appendicitis. We found a significant reduction in accurate pre-operative diagnoses, a longer duration of hospital stay and increased complication and mortality rates in the elderly group. Our study suggests that diagnostic accuracy, mortality and morbidity have not improved in comparison to earlier overseas studies.