Appendicitis is one of the most common pathologies of the abdomen. Acute appendicitis has been shown to affect 90–100/100,000 inhabitants in developed countries with the geriatric population making up about 5–10% of these cases. It has been associated with direct luminal obstruction, infectious etiology, summer months, and possibly genetic factors. The traditional thought of linear progression of acute appendicitis from simple inflammation to frank perforation has changed with growing evidence that simple and complex appendicitis are distinctly different disease processes with different fates. In the elderly population, RLQ pain has been the most consistent finding; however due to socioeconomic factors, dementia, etc., these patients may have a delay in diagnosis. Therefore, the infectious process may be advanced at the time of diagnosis. Computed tomography is the imaging modality of choice for evaluating the appendix, and for older populations at increased risk of malignancy, it may be particularly useful for discovering occult malignancy. Surgery is the standard of care. However, antibiotics have been found to be a safe alternative that should be considered in this often medically complex patient population, poorly suited for surgery.
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