ACUTE ABDOMEN IN THE ELDERLY- INCIDENCE, AETIOLOGY, CLINICAL PATTERN AND TREATMENT OUTCOME
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 23
Abstract
BACKGROUND Acute abdomen is the commonest cause of admission in surgical emergencies even in the present era where trauma cases have increased manifold. It is also a common occurrence in the elderly patients. Most authors define patients older than 60 years as elderly and the associated geriatric emergency cases have posed significant diagnostic and management challenges, in part due to patients’ tendency to delay seeking medical care, atypical presentations, presence of coexisting diseases, atypical physical examination findings, atypical laboratory values and higher morbidity and mortality. MATERIALS AND METHODS The prospective observational clinical study was conducted on 113 patients aged above 60 years attending Regional Institute of Medical Sciences (RIMS) outpatient department and emergency services with acute abdomen and admitted in the Department of Surgery, RIMS, Imphal, Manipur, from October 2013 to September 2015. Study was done through questionnaires and clinical examination, biochemical investigations including renal function tests, liver function tests and serum electrolytes. X-ray erect abdomen, C T scan abdomen, upper GI endoscopy, X-ray Barium studies and Colonoscopy were performed if required on case to case basis. Laparotomy and histopathological examination was done wherever necessary/possible and data was analysed using SPSS version 16. RESULTS The mean age of presentation was 67.25 years, ranging from 60 to 92 years of age. Males comprised 53.1% and females were 46.9%. Around 66.7% of acute abdomen patients presented within 48 hours and 93.9% of them presented within 5 days. Generalised tenderness was present in 23.5% of patients and 30.9% of patients had pain restricted to a single region. Acute cholecystitis (28.3%) was the commonest condition followed by acute appendicitis (19.4%), acute intestinal obstruction (16.8%), malignancy (13.8%) and perforation peritonitis (8.1%). CONCLUSION The mean age of presentation was 67.25 years and no statistically significant differences in age and sex distribution. Ultrasound screening of whole abdomen is the most useful investigation in the rest. Surgical operation should be anticipated in patients with anorexia, pyrexia, shock, dehydration, rebound tenderness, guarding, obliteration of liver dullness, leukocytosis, urinary abnormalities.
Authors and Affiliations
Chinglensana Laitonjam, Sunilkumar Singh Salam, Vinay H. D, Priyabarta Yumnam, Birkumar Sharma Manoharmayum
Keywords
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- EP ID EP563598
- DOI 10.18410/jebmh/2018/365
- Views 72
- Downloads 0
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