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2016, Number 3

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Cir Gen 2016; 38 (3)

Diagnostic errors in acute appendicitis in the elderly. Study of a clinical case and revision of the literature

Herrera CL, Joffe FJ, Llamas PLE

Language: Spanish
References: 41
Page: 149-157
PDF size: 404.57 Kb.


ABSTRACT

Introduction: For more than six decades, acute appendicitis in the aged remains a difficult diagnosis that results in a delay in an appropriate treatment. Appendicitis in the elderly is characterized by a delay in the diagnosis and treatment of multifactorial nature. The usual finding during surgery is an appendix with regional or widespread peritonitis. Death in these patients is secondary to abdominal sepsis by bacterial seeding of intestinal origin. The postoperative course in an old person with a minimal inflammatory process in the cecal appendix, such as the one described in this case, is usually benign if there is an appropriate control of peritoneal contamination. If comorbidity does not intervene in the postoperative period, hospital discharge is rapid. Case report: In the case that is presented, the cecal appendix was normal, as shown in the picture. We decided to resect it because of the absence of other abnormalities in the abdominal cavity. The histopathological study described inflammatory changes confined to the mucosa and submucosa. There was no perforation. These changes might have been secondary to a severe hypoperfusion due to the state of the patient. Conclusions: It is dangerous to conclude that “although the cecal appendix in older patients might seem normal, it would be very reasonable to remove it” to avoid an outcome like that of the case presented.


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