The Surgical Abdomen

  • Carlos A. Pelaez
  • Nanakram Agarwal


Abdominal pain is a common and challenging problem in the geriatric population, characterized by abrupt severe pain that requires an urgent and specific diagnosis. A rapidly worsening prognosis may occur in absence of prompt intervention. The most common causes of acute abdomen in the older age group are cholecystitis, appendicitis, perforated peptic ulcer disease, pancreatitis, intestinal obstruction, ischemic bowel disease, diverticulitis, and obstructed hernias. Symptoms and physical findings are unreliable in the elderly, contributing to misdiagnosis in approximately 40% of the patients. Inordinate delays of initial assessment, diagnosis, and treatment contribute to significantly increased mortality. Upright chest X-ray initially to exclude free intraperitoneal air, followed by CT, has the highest yield. Older adults have acceptable survival rates after major abdominal surgery, but tolerate complications poorly. Early diagnosis, aggressive resuscitation, and prompt surgical intervention tailored to the physiologic status improve survival in the geriatric patient.


Small Bowel Obstruction Common Bile Duct Stone Biliary Tract Disease Perforated Peptic Ulcer Laparoscopic Common Bile Duct Exploration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Elinhouser A, Andrews RM. Profile of inpatient operating room procedures in U.S. hospitals in 2007. Arch Surg. 2010;145:1201–8.CrossRefGoogle Scholar
  2. 2.
    Richardson J, Cocanour C, Kern J, et al. Perioperative risk assessment in the elderly and high risk patients. J Am Coll Surg. 2004;199:133.PubMedCrossRefGoogle Scholar
  3. 3.
    Brunicardi FC, Andersen DK, Billiar TR, et al., editors. Schwartz’s principles of surgery. 9th ed. New York: McGraw-Hill; 2009.Google Scholar
  4. 4.
    Silen W, editor. Cope’s early diagnosis of the acute abdomen. 20th ed. New York: Oxford University Press; 2001.Google Scholar
  5. 5.
    Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Phys. 2006;74(9):1537–44.Google Scholar
  6. 6.
    Hendrickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Med Clinic North Am. 2003;21:937–69.CrossRefGoogle Scholar
  7. 7.
    Thomas SH, Silen W, Cheama F, et al. Effects of morphine analgesia in the diagnostic accuracy in the emergency department in patients with abdominal pain. A prospective randomized trial. J Am Coll Surg. 2003;196:18.PubMedCrossRefGoogle Scholar
  8. 8.
    Shikata S, Noguchi Y, Fukui T. Early versus delayed cholecystectomy: a meta-analysis of randomized control trials. Surg Today. 2005;35(7):553–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Tsai MJ, Chen JD, Tiu CM, et al. Can acute cholecytitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features. Am J Emerg Med. 2009;27(5):574–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Goldacre MJ, Duncan ME, Griffith M, Davidson M. Trends in mortality from appendicitis and from gallstone disease in English populations, 1979–2006: study of multiple-cause coding of deaths. Postgrad Med J. 2011;87:245–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Hui TT, Major KM, Avital I, et al. Outcome of elderly patients with appendicitis. Effect of computed tomography and laparoscopy. Arch Surg. 2002;137:995–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 2010;34(2):199–209.PubMedCrossRefGoogle Scholar
  13. 13.
    McCarthy DM. Acid peptic disease in the elderly. Clin Geriatr Med. 1991;137:995–8.Google Scholar
  14. 14.
    Kocer B, Surmeli S, Solak C, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22(4):565–70.PubMedCrossRefGoogle Scholar
  15. 15.
    Datsis AC, Rogdakis A, Kekelos S, et al. Simple closure of chronic duodenal ulcer perforation in the era of Helicobacter pylori: an old procedure, today’s solution. Hepatogastroenterology. 2003;50(53):1396–8.PubMedGoogle Scholar
  16. 16.
    Rafferty J, Shellito P, Hyman NH. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49(7):939–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Maginte DD, Heitkamp DE, Howard TJ. Current concepts in imaging of small bowel obstruction. Radiol Clin Am. 2003;41:263.CrossRefGoogle Scholar
  18. 18.
    Branco BC, Barnporas G, Schnuriger B, et al. Systemic review and meta-analysis of the diagnostic and therapeutic role of water-­soluble contrast agent in adhesive small bowel obstruction. Br J Surg. 2010;97:470.PubMedCrossRefGoogle Scholar
  19. 19.
    Stewardson RH, Bombech CT, Nyhus LM. Critical operative management of small bowel obstruction. Ann Surg. 1987;206:126.CrossRefGoogle Scholar
  20. 20.
    Steward RH, Page CP, Brendon J, et al. The incidence and risk of early postoperative small bowel obstruction. A cohort study. Am J Surg. 1987;154:643.CrossRefGoogle Scholar
  21. 21.
    Avots-Avotins KV, Waugh DE. Colon volvulus and the geriatric patient. Surg Clin North Am. 1982;62:249.PubMedGoogle Scholar
  22. 22.
    Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12(7):1–17.Google Scholar
  23. 23.
    Atamanalp S, Yildirgan M, Bosuglu M, et al. Retraction. Clinical presentation and diagnosis of sigmoid volvulus: outcomes of 40-year and 859-patient experience. J Gastroenterol Hepatol. 2009;24:1154–9.CrossRefGoogle Scholar
  24. 24.
    Peoples J, McCafferty J, Scher K. Operative therapy for sigmoid volvulus. Identification of risk factors affecting outcome. Dis Colon Rectum. 1990;33:643.PubMedCrossRefGoogle Scholar
  25. 25.
    Friedman J, Odland M, Bubrick M. Experience with colon volvulus. Dis Colon Rectum. 1989;32:409.PubMedCrossRefGoogle Scholar
  26. 26.
    Nyhus LM, Bombeck CT, Klein MS. Hernias. In: Sabiston DC, editor. Textbook of surgery. 14th ed. Philadelphia: WB Saunders; 1991.Google Scholar
  27. 27.
    Rogers FB, Guzman EA. Inguinal hernia repair in a community setting: implications for the elderly. Hernia. 2011;15(1):37–42.PubMedCrossRefGoogle Scholar
  28. 28.
    Nilsson H, Stylianidis G, Haapamäki M, Nilsson E, Nordin P. Mortality after groin hernia surgery. Ann Surg. 2007;245(4): 656–60.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Carlos A. Pelaez
    • 1
  • Nanakram Agarwal
    • 1
  1. 1.Department of SurgeryMontefiore Medical Center (North Division)BronxUSA

Personalised recommendations