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Appendicitis

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Geriatric Trauma and Critical Care

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Abstract

The relative risk of developing appendicitis in patients greater than 50 years of age has been estimated to be between 2 and 3 %, representing approximately 5 % of all elderly patients presenting with an acute abdomen. The incidence of geriatric appendicitis appears to be increasing, which is likely due to increasing life expectancy and a larger proportion of elder individuals in our society. The early diagnosis of acute appendicitis in this age group continues to be a challenge for physicians, due to the increased scope of the differential diagnosis of acute abdominal pain. This increased difficulty in diagnosis is coupled with a later presentation due to hesitancy in seeking medical care, leading to more advanced pathology on presentation. The diagnosis is often made radiographically, often using ultrasound or computed tomography, rather than physical examination. Surgical resection of the inflamed appendix remains the standard of care. However, in the age of laparoscopic surgery, the benefits of minimally invasive surgery in older patients present an intriguing alternative to the traditional right lower quadrant incision. As imaging capabilities have advanced, so too has the field of interventional radiology. This has allowed selected cases of perforated appendicitis to be treated with antibiotics along with drainage of periappendiceal abscesses. Cancer of the appendix is an uncommon finding, occurring in approximately 1 % of appendectomy specimens, and accounts for roughly 0.5 % of intestinal neoplasms. Carcinoid tumors are the most common, comprising over 50 % of appendiceal neoplasms. The term appendiceal mucocele refers to any lesion that is characterized by a distended, mucus-filled appendix. It may either be a benign or malignant condition. The course and prognosis of appendiceal mucoceles are related to their histologic subtypes which include mucosal hyperplasia, simple or retention cysts, mucinous cystadenomas, and mucinous cystadenocarcinomas.

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  1. Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale School of Medicine, 330 Cedar Street, BB 310, 208062, New Haven, CT, 06520-8062, USA

    Michael F. Ditillo DO & Kimberly A. Davis MD, MBA

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  1. Michael F. Ditillo DO
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  2. Kimberly A. Davis MD, MBA
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Correspondence to Kimberly A. Davis MD, MBA .

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  1. Department of Surgery, Lincoln Medical Center, Bronx, New York, USA

    Jay A. Yelon

  2. Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA

    Fred A. Luchette

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Ditillo, M.F., Davis, K.A. (2014). Appendicitis. In: Yelon, J., Luchette, F. (eds) Geriatric Trauma and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8501-8_11

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