Acute appendicitis in the elderly: risk factors for perforation

Abstract

BackgroundAcute appendicitis is the most common surgical emergency and becomes serious when it perforates. Perforation is more frequent in the elderly patients. The aim of this study was to identify the risk factors of perforation in elderly patients who presented with acute appendicitis.MethodologyThe medical records of 214 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis over a period of 10 years (2003-2013) were retrospectively reviewed. Patients were grouped into those with perforated and those with nonperforated appendicitis. Comparison was made between both groups in regard to demography, clinical presentation, and time delay to surgery, diagnosis, hospital stay and postoperative complications. Clinical assessment, Ultrasonography and Computerized tomography, in that order, were used for diagnosis. The incidence of perforation was also compared with a previous report from the same region 10 years earlier.ResultsDuring the study period, a total of 214 patients over the age of 60 years had acute appendicitis, 103 males and 111 females. Appendix was found perforated in 87 (41%) patients, 46 (53%) males and 41 (47%) females. Of all patients, 31% were diagnosed by clinical assessment alone, 40% needed US and 29% CT scan. Of all the risk factors studied, the patient’s pre-hospital time delay was the most important risk factor for perforation. Perforation rate was not dependent on the presence of comorbid diseases or in-hospital time delay. Post operative complications occurred in 44 (21%) patients and they were three times more common in the perforated group, 33 (75%) patients in the perforated and 11 (25%) in the nonperforated group. There were 6 deaths (3%), 4 in the perforated and 2 in the nonperforated group.ConclusionAcute appendicitis in elderly patients is a serious disease that requires early diagnosis and treatment. Appendiceal Perforation increases both mortality and morbidity. All elderly patients presented to the hospital with abdominal pain should be admitted and investigated. The early use of CT scan can cut short the way to the appropriate treatment.

Knowledge Assessment of Appendicitis among Saudi Population

“…Table ( [3][4][5] shows that (16.7%) of the respondents believe that the appendix is in the stomach, while (23.6%) of the sample believe that the appendix is in the small intestine, (39.5%) of the sample believed that the appendix was in the intestinal tract, (1.1%) of the sample believed that the appendix was in the anus, and (19.1%) of the sample did not know where the appendix was located in the body. Table (3)(4)(5)(6) shows that (11.8%) of the respondents believe that the function of the appendix is to digest food, while (5.8%) of the sample believe that the function of the appendix is to help the body break down fats , (49.7%) of the sample believe that the appendix has no benefits, and (32.7%) of the sample did not know the function of appendix . Table 3.8 shows that (3.8%) of respondents had an excellent background about appendicitis, while (11.3%) of respondents had a good background about appendicitis, (39.3%) of respondents had a medium background about appendicitis and (45.6%) did not have any background about appendicitis.…”

“…Table ( [3][4][5][6][7][8][9][10][11][12] shows that 39.2% of the sample saw the cause of appendicitis is obstruction in appendicitis muscle, while 4.5% of the sample thought that the cause of appendicitis was Abdominal muscle weakness, (9.1%) of the sample believed that the cause of the appendicitis was Genetic and (47.2%) of the sample did not know the cause of appendicitis. Figure 12 shows the distribution of the sample according to the cause of appendicitis 13 Distribution of the sample by whether they think food poisoning causes appendicitis: Table ( [3][4][5][6][7][8][9][10][11][12][13][14] shows that (3.7%) of the respondents believe that the appendicitis pain located on the left upper side of the abdomen, while (5.8%) of the respondents believe that the appendicitis pain located on the right upper side Of the abdomen, Table (3-16) shows that (22.1%) of respondents believe that appendicitis is more common in males, while (7.1%) of the sample believe that appendicitis is more common in females, (43.2%) of the sample believed it's the same (No difference), and (27.6%) of the respondents do not know. Table ( [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]…”

“…shows the distribution of the sample according to the background about appendicitis 8 Distribution of the sample according to whether they ever had appendicitis Table ( [3][4][5][6][7][8] shows that (95.4%) of the sample never had appendicitis, while (4.6%) of the sample were previously suffered from appendicitis Table (3-11) shows that (1.7%) of the sample found that appendicitis often occurs in the age of 1 to 5 years old, while (71.3%) of the sample believes that appendicitis often affects people from 10 to 30 years old, (24.3%) of the sample believed that appendicitis often occurs in people aged 30 to 50 and (2.6%) of the sample thinks appendicitis affects people over the age of 50. Table ( [3][4][5][6][7][8][9][10][11][12] shows that 39.2% of the sample saw the cause of appendicitis is obstruction in appendicitis muscle, while 4.5% of the sample thought that the cause of appendicitis was Abdominal muscle weakness, (9.1%) of the sample believed that the cause of the appendicitis was Genetic and (47.2%) of the sample did not know the cause of appendicitis.…”

Max appendicitis score: a new diagnostic score for diagnosing acute appendicitis

“…1 Around 6% of general population is believed to have appendicitis in their lifespan. 2 Acute appendicites is still the commonest abdominal surgical emergency with a lifetime incidence of 7%. 2 In 1886 Fits RH described classical signs and symptoms of acute appendicitis as a disease entity.…”

“…2 Acute appendicites is still the commonest abdominal surgical emergency with a lifetime incidence of 7%. 2 In 1886 Fits RH described classical signs and symptoms of acute appendicitis as a disease entity. 3 The diagnosis of acute appendicitis is based purely on clinical history and examination combined with laboratory investigations.…”