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Acute Appendicitis in Older Patients

Nellia Gwasunda, Rafal Al-Rabaey, Vasil Bozhkov, Rossen Madjov


Introduction: The aim of this project is to aid in finding and distinguishing the diagnosis of acute appendicitis in older patients.

As a result of socio-economic development and achievements in the field of medical science, the average life expectancy is increasing in Bulgaria, as in most countries. This has led to an increase in the number of older patients diagnosed with acute appendicitis. Acute appendicitis is one of the most common diseases presenting with severe abdominal pain and requiring surgery in all cases. While it is typically associated with younger patients, the demographic changes lead to an increased rate of incidence in adult or elderly patients, in which the diagnosis of acute appendicitis is a more complex and challenging process compared to young or middle-aged patients. The reasons for this could be the atypical clinical presentation and enhanced communication problems, as well as several differential diagnoses.

Materials and Methods: During the period between 2007 and 2016 a total of 243 patients with acute appendicitis were admitted and operated at the St. Marina University Hospital. Of them, 141 were women (58.1%) and 102 - men (41.9%) with the ratio 1.4: 1. The patients were divided into two groups: of up to 60 years old and over 60 years. The most frequent reported symptoms were: pain in the right lower quadrant, elevated values of leucocytes, fever and anorexia.

Results: The ratio of destructive forms of acute appendicitis between the two groups was 64.8% (over 60y) and 35.2% (up to 60y).

Conclusion: Acute appendicitis is one of the most common diseases occurring with abdominal pain, requiring surgery. In elderly patients, the diagnosis is difficult because of atypical clinical presentation, extended differential diagnosis, delayed hospital visit and communication difficulties.


acute appendicitis, surgery, old age



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