ACUTE APPENDICITIS IN ELDERLY PATIENTS- CHALLENGES IN DIAGNOSIS AND MANAGEMENT
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 32
Abstract
BACKGROUND Acute appendicitis in elderly patients presents with delayed and atypical presentations and it leads to increased frequency of perforation and intra-abdominal infections requiring prompt diagnosis and surgical intervention. MATERIALS AND METHODS The cross-sectional study was conducted on patients with diagnosis of acute appendicitis aged 60 years and above, admitted in the surgical wards of Department of Surgery, RIMS, Imphal. The study was conducted for a period of 2 years from September 2014 to September 2016. RESULTS Majority of the patients were from the age group 60 - 70 years (66.7%). Males were more than females (55.6% vs. 44.4%). More than half of the patients were from urban areas (55.6%) and majority were from middle class families (88.8%). All the patients in the study presented with pain abdomen, 10 patients (18.5%) with typical pain abdomen and 44 patients (81.4%) with atypical pain abdomen. In 18 cases (33.3%), there was history of anorexia and 18 cases (33.3%) gave a history of vomiting with varying frequency. Fever was present in 30 cases (55.6%). 2 patients (3.7%) had diarrhoea and 25 (46.2%) gave history of constipation. Majority of the patients (81.4%) were diagnosed as acute appendicitis, 11.1% as appendicular abscess and appendicular perforation in 7.4% of cases. Appendicectomy was performed in 29 patients (53.7%), laparotomy was performed in 1 case (1.8%), where there was generalised peritonitis and incision and drainage done in 6 cases (11.1%) and non-operative treatment considered in 18 patients (33.3%). CONCLUSION Acute appendicitis is a common surgical emergency and is a frequently suspected differential diagnosis presenting with acute abdominal pain. Majority of the patients usually present late, commoner in male sex, lives in urban areas. Most of the patients had atypical presentation with only 18.5% having typical presentation. Resuscitation plays a key role, while monitoring an elderly patient with acute abdomen before a clinical diagnosis is made. Presence of any co-morbid condition, which is a common finding in elderly increases the morbidity and mortality
Authors and Affiliations
Sunilkumar Singh Salam, Laitonjam Chinglensana, Vanlalremsiama Vanlalremsiama, Yumnam Priyabarta, Manoharmayum Birkumar Sharma
Keywords
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- EP ID EP541161
- DOI 10.14260/jemds/2018/805
- Views 64
- Downloads 0
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