Appendicitis in the Elderly

Appendicitis in the elderly is a pathological process. It is common in many locales, populations and cultures. It is a potentially life threatening pathology. Lifetime incidence is 1 in every 15 persons (7%) with a prevalence rate of ten in one hundred thousand people (10/100,000) (Condon RE, 1986). Appendicitis usually affects people who are previously healthy. The rate of appendicitis among the elderly varies from 5% to 10% of appendicitis cases. Appendicitis is often thought of as a disease of the young but it has now become a disease of the elderly because of increasing life expectancy of the modern day man resulting from improved medical attention. It is the most common cause of acute surgical condition of the abdomen (Hardin D, 1999, Storm-Dickerson T.L. & Horattas, M.C., 2003). Appendicitis requires immediate surgical excision in most cases as soon as the condition is diagnosed unless contraindicated. If appendicectomy is carried out early, the end result is low morbidity and mortality. The cure rate is high if managed early without any long term sequelae (Birnbaum BA & Wilson SR, 2000; Ellis H, 1989). This write up will focus on appendicitis in the elderly. The elderly as defined in this discussion are people who are sixty years of age and above. The high occurrence of appendicitis has made the pathology a very important entity that should not be under estimated. The usual peak incidence of appendicitis in the general population is in the range 15 to 24years age group. This accounts for 5% of all acute abdominal conditions in the aged 65years and above (Sheu, B F. et al, 2007; Storm-Dickerson T.L. & Horattas M.C., 2003). The elderly patients have a lowered physiological reserve. Inflammatory effect is much increased in the elderly. Hence appendicitis has a more fulminant outcome in this group of patients. The mortality can be as high as 16 times as what is obtainable in the young adult with appendicitis (Hui TT, et al, 2002; Semm K, 1983). There has been increased use of computed tomography (CT) in the last two decades. This investigative tool has improved the diagnosis of appendicitis (Horattas M, 1990). In the area of care, laparoscopy has revolutionized the care of appendicitis since the introduction of the first laparoscopy appendicectomy performed in 1983 by Semm (Tehrani H, 1999). A high rate of misdiagnosis of appendicitis in the elderly has been documented (Hale D, 1997). This is because this disease simulates much other pathology in the elderly. The elderly people have deteriorating functions of their organs system which in that state may mimic the pathology of appendicitis. Some of these pathologies shall be discussed latter in this write up. The presentation of appendicitis can be traditional or non classical. There is high rate of atypical or non classical presentation among the elderly patients than in the general setting. In contrast to this, the majority of young adults present classically. This atypical presentation in the elderly patients leads to delay diagnosis with resulting high