Appendicitis an important differential diagnosis in the elderly
Older adults presenting with abdominal pain should be screened for appendicitis.
HealthDay News — Appendicitis should be considered for older adults presenting with abdominal pain or nonspecific symptoms, according to a letter to the editor published in the June issue of the Journal of the American Geriatrics Society.
Léa Guibentif, MD, from the Geneva University Hospitals and Medical School, and colleagues describe two cases of perforated appendicitis with delayed diagnosis in older adults.
The authors describe an 83-year-old male patient who was admitted for confusion and fall without significant trauma. Tenderness of the right iliac fossa was revealed on examination, and a painless, nonreducible inguinoscrotal hernia was identified on the right side. On abdominal computed tomography (CT), the vermiform appendix was located within the hernia sac. Emergency appendectomy and hernia repair surgery were performed, with a favorable postoperative outcome. The second patient was an 87-year-old man admitted after a fall. He had no clinical signs of infection. After persistent fever, nonspecific infiltration in the right iliac fossa was identified on thoraco-abdominal CT. The patient complained of increasing pain in the right lower abdomen after 2 additional days. Eight days after admission the patient had acute abdominal tenderness in the right lower quadrant, and abdominal CT revealed appendicitis. Emergency appendectomy and abscess drainage were performed; the postoperative evaluation was favorable.
"Clinicians should be aware that appendicitis remains an important differential diagnosis in elderly adults with abdominal pain or unspecific symptoms such as fever, leukocytosis, and altered mental status," the authors write.
- Guibentif L, Ris F, Scheffler M, et al. Acute appendicitis in elderly adults: a difficult diagnosis. J Am Geriatr Soc. 2016;64(6):1377-1379; doi: 10.1111/jgs.14158