Cirujano General

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirujano General >Year 2016, Issue 3

Herrera CL, Joffe FJ, Llamas PLE
Diagnostic errors in acute appendicitis in the elderly. Study of a clinical case and revision of the literature
Cir Gen 2016; 38 (3)

Language: Español
References: 41
Page: 149-157
PDF: 4. Kb.

Full text


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.

Key words: Appendicitis in the aged, difficult diagnosis, early diagnosis and surgical treatment.


  1. Peltokallio P, Jauhiainen K. Acute appendicitis in the aged patient. Study of 300 cases after the age of 60. Arch Surg. 1970; 100: 140-143.

  2. Søreide O. Appendicitis —a study of incidence, death rates and consumption of hospital resources. Postgrad Med J. 1984; 60: 341-345.

  3. Horattas MC, Haught R. Managing appendicitis in the elderly patient. AORN J. 1992; 55: 1282-1285.

  4. Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990; 160: 282-285.

  5. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995; 61: 40-44.

  6. Peltokallio P, Tykkä H. Evolution of the age distribution and mortality of acute appendicitis. Arch Surg. 1981; 116: 153-156.

  7. Lau WY, Fan ST, Yiu TF, Chu KW, Lee JM. Acute appendicitis in the elderly. Surg Gynecol Obstet. 1985; 161: 157-160.

  8. Leigh DA, Simmons K, Norman E. Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection. J Clin Pathol. 1974; 27: 997-1000.

  9. Smithy WB, Wexner SD, Dailey TH. The diagnosis and treatment of acute appendicitis in the aged. Dis Colon Rectum. 1986; 29: 170-173.

  10. McCaig LF, Nawar EN. National hospital ambulatory medical care survey: 2004 emergency department summary. Advance date from vital and health statistics. Adv Data. 2006; 372: 1-29.

  11. Wilber ST, Gerson LW, Terrell KM, Carpenter CR, Shah MN, Heard K, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system. Acad Emerg Med. 2006; 13: 1345-1351.

  12. Wofford JL, Schwartz E, Timerding BL, Folmar S, Ellis SD, Messick CH. Emergency department utilization by the elderly: analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med. 1996; 3: 694-699.

  13. McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med. 1992; 212: 796-801.

  14. Coroş MF, Copotoiu C, Copotoiu S, Ioniţă S, Dobre A, Sorlea S, et al. Surgical emergencies in elderly. Chirurgia (Bucur). 2008; 103: 283-290.

  15. De Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol. 1994; 19: 331-335.

  16. Ongrádi J, Stercz B, Kövesdi V, Vértes L. Immunosenescence and vaccination of the elderly II. New strategies to restore age-related immune impairment. Acta Microbiol Immunol Hung. 2009; 56: 301-312.

  17. Cusi MG, Martorelli B, Di Genova G, Terrosi C, Campoccia G, Correale P. Age related changes in T cell mediated immune response and effector memory to Respiratory Syncytial Virus (RSV) in healthy subjects. Immun Ageing. 2010; 7: 14.

  18. Grubeck-Loebenstein B. Fading immune protection in old age: vaccination in the elderly. J Comp Pathol. 2010; 142 Suppl 1: S116-S119.

  19. Zhou XJ, Saxena R, Liu Z, Vaziri ND, Silva FG. Renal senescence in 2008: progress and challenges. Int Urol Nephrol. 2008; 40: 823-839.

  20. Cotreau MM, von Moltke LL, Greenblatt DJ. The influence of age and sex on the 
clearance of cytochrome P450 3A substrates. Clin Pharmacokinet. 2005; 44: 33-60.

  21. Radley S, Keighley MR, Radley SC, Mann CH. Bowel dysfunction following hysterectomy. Br J Obstet Gynaecol. 1999; 106: 1120-1125.

  22. Bhutto A, Morley JE. The clinical significance of gastrointestinal changes with 
aging. Curr Opin Clin Nutr Metab Care. 2008; 11: 651-660.

  23. Wickremaratchi MM, Llewelyn JG. Effects of ageing on touch. Postgrad Med J. 2006; 82: 301-304.

  24. Hilton D, Iman N, Burke GJ, Moore A, O’Mara G, Signorini D, et al. Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study. Am J Gastroenterol. 2001; 96: 380-384.

  25. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003; 21: 61-72, vi.

  26. Stroman DL, Bayouth CV, Kuhn JA, Westmoreland M, Jones RC, Fisher TL, et al. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg. 1999; 178: 485-489.

  27. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998; 338: 141-146.

  28. Wolff WL, Hindman R. Acute appendicitis in the aged. Br J Sur. 1976; 63: 956-960.

  29. Goldenberg IS. Acute appendicitis in the aged. Geriatrics. 1955; 10: 324-327.

  30. Hubbell DS, Barton WK, Solomon OD. Appendicitis in older people. Surg Gynecol Obstet. 1960; 110: 289-292.

  31. Coran AG, Wheeler HB. Early perforation in appendicitis after age 60. JAMA. 1966; 197: 745-748.

  32. Albano WA, Zielinski CM, Organ CH. Is appendicitis in the aged really different? Geriatrics. 1975; 30: 81-88.

  33. Freund HR, Rubinstein E. Appendicitis in the aged. Is it really different? Am Surg. 1984; 50: 573-576.

  34. Owens BJ, Hamit HF. Appendicitis in the elderly. Ann Surg. 1978; 187: 392-396.

  35. Blake R, Lynn J. Emergency abdominal surgery in the aged. Br J Surg. 1976; 63: 956-960.

  36. Pieper R, Kager L, Näsman P. Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand. 1982; 148: 51-62.

  37. Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990; 160: 291-293.

  38. Lukmann R. Incidence and case fatality rates for acute appendicitis in California. A population-base study of effects of age. Am J Epidermiol. 1989; 129: 905-918.

  39. Paajanen H, Kettunen J, Kostianen S. Emergency appendicitis in patients over 80 years old. Am Surg. 1994; 60: 950-953.

  40. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995; 61: 40-44.

  41. Rub R, Margel D, Soffer D, Kluger Y. Appendicitis in the elderly: what has changed? Isr Med Assoc J. 2000; 2: 220-223.

>Journals >Cirujano General >Year 2016, Issue 3

· Journal Index 
· Links 

Copyright 2019