Surgery in the very elderly

Abstract

A 102-year-old woman was previously well, independent in her daily activities and lived with her son. She presented to our hospital with a 3-day history of non-specific abdominal and bilateral upper leg pain, absolute constipation and one episode of dark vomitus. On examination, she was 55 kg, slightly dehydrated, afebrile, blood pressure 130/85 mmHg, pulse rate 80/min, respiratory rate 18/min and S A O 2 99% with room air. Her abdomen was mildly distended and tender on deep palpation centrally. There was no other significant finding on examination. She was reviewed by a geriatrician the next morning and was found to have both hips in flexion position with no visible femoral or inguinal hernia.Plain abdominal radiograph showed dilated loops of small bowel with multiple fluid levels on decubitus views. Chest radiograph showed no gas under the diaphragm. Her urea was slightly raised at 15 mm/L, white cell count was mildly increased at 12.2 Â 10 6 /L, whereas electrolytes, amylase, lipase, haemoglobin and platelets were normal.Obturator hernia was suspected and was confirmed by abdominal computed tomography (CT) scan, which showed a solitary bowel loop in the left obturator canal posterior to the pectineus muscle. Emergency laparotomy was carried out, which showed complete distal small bowel obstruction secondary to the hernia. A 10-cm segment of infracted small bowel was resected. The hernia was reduced and small bowel anastomosis was carried out; peritoneum over the obturator space was opened with polypropylene mesh repair.

Successful tongue cancer surgery under general anesthesia in a 99-year-old patient in Okinawa, Japan: A case report and review of the literature

“…The National Cancer Center Network (NCCN) has published a series of guidelines indicating that, in general, age is not the primary consideration for surgical risk (11). Although surgery under general anesthesia in nonagenarians and centenarians is not without risk, available studies regarding surgery in centenarians suggest that there is no significantly increased risk of mortality (12–15). Results of a previous study of nonagenarians and centenarians support the hypothesis that cardiac surgical procedures may appropriately be performed on a higher-risk patient group independent of age (16).…”

“…Prehospital and postoperative nutritional status may also serve an important role in the surgical outcomes for centenarians (2,20), and thus, in the present case, oral feeding was resumed 6 h post-surgery. Furthermore, a coordinated care approach between surgical and geriatric medical teams is highly desirable to achieve positive outcomes (15,21). …”