| [ Summary ] |
Thirty-nine patients aged 70 years or older treated for acute appendicitis during the past ten years were reviewed. The chief complaint in 37 patients was pain.Half of them initially had epigastric or periumbilical pain, which shifted to the right lower quadrant. Gastrointestinal tract symptoms were common and variable. Physical examination revealed right lower quadrant tenderness in all patients, rebound tenderness in 82 percent and muscle rigidity in 41 percent. Twenty seven patients underwent appendectomies and 12 were managed successfully through non-surgical treatment. The incidence of perforation was 52 percent. Although a fever higher than 38 degrees centigrade or a white blood cell count greater than 15,00O/micro l indicated gangrenous or perforated appendicitis, these were variable even in patients with perforated appendicitis. Ultrasound and CT examination are useful to confirm the diagnosis when the symptoms and physical findings are mild or atypical. Early diagnosis and surgery are important principles in treating elderly patients with acute appendicitis. In cases of conservative treatment, surgical treatment should be considered for those patients who fail to improve within one day. |