Acute Appendicitis In Elderly - An Uncommon Presentation

Introduction: Acute appendicitis in the elderly presents uniquely, often with atypical symptoms (less fever, pain) because of reduced pain perception and immune response which means less pronounced abdominal pain, fever, or classic signs like anorexia, leading to delayed recognition and a higher risk of severe complications like perforation and sepsis, due to delayed diagnosis and underlying comorbidities like diabetes mellitus and heart diseases. While less common than in younger adults, it's a significant concern, requiring vigilant diagnosis (considering malignancy) and often leading to worse outcomes if not caught quickly, though management options like surgery (laparoscopic or open) or sometimes antibiotics are considered, depending on frailty. Elderly patients face higher morbidity and mortality due to advanced age, delayed presentation, and comorbidities, often needing intensive care. The CECT scan abdomen is the diagnostic modality of choice. Case report: A sixty-five-year-old female was on regular treatment for hypertension presented with acute pain abdomen fifteen days back which subsided after four days of symptomatic treatment by private practitioner. The pain was associated with low grade fever and vomiting for initial two days. The pain was in starting generalized and after one day localized to right iliac fossa. The first ultrasonogram abdomen done after one week of first episode of pain showed mild thickening in ileocecal area. In view of old age and for confirming the diagnosis, especially to rule out any malignancy, computed tomography scan of abdomen was done which showed thickened appendix (wall thickness of 10 mm) and measuring 24 mm in diameter with fat stranding of surrounding mesenteric fat. It was retrocecal in position and not opacified by oral contrast. No appendicolith or local collection was noted. Mild mural wall thickening of base of caecum was seen. The final impression was acute appendicitis. The surgical consultation was taken who have planned for interval laparoscopic cholecystectomy after six weeks of initial attack. Conclusion: Acute appendicitis is not common in elderly but should be ruled out in patients with acute pain abdomen. It carries less favorable prognosis in comparison to young because of associated co-morbidities. Keywords: Elderly, Acute Appendicitis, CECT scan, Pain abdomen, Umbilical area