Abstract

CHIAN CHANG, Víctor E; VICUNA VALLE, Ricardo I  and  BARACCO MILLER, Víctor. Acute appendicitis in the ancient: clinical and laboratory aspects. Rev Med Hered [online]. 1996, vol.7, n.1, pp.17-23. ISSN 1018-130X.

Objective: To evaluate the clinical presentation, the clinico-pathological relationship and the relevance of laboratory analysis in the definition of acute appendicitis (AA) in the elderly. Material y Methods: A retrospective study was carried out in 100 patients of more than 60 years old that were hospitalized in the emergency room at the Hospital Nacional Arzobispo Loayza in Lima, Perú from 1984 to 1994. Results: During the observed period a total of 4447 of AA in all ages were attended of which 3.89% were elderly patients. The average duration of disease was 3.5 days. Patients with longer duration of disease had higher incidence of apendicular perforation (X²=19.28, p<0.05). All the patients studied had abdominal pain, but only 43% had the typical progression of this symptom, it was demonstrated that the older patients had a greater frequency of non-classic abdominal pain (X2=4.93, p<0.05). Other symptoms associated were nausea (73%), vomit (63%) and hiporexia (52%). The most frequent sign was Mc Burney (96.5%), other sign important for its frequency was Psoas sign (73.7%). Fever was only detected in 43.8% of the patients. The hemogram was normal in 28% and the urine sediment was pathological in 67.2%. 56% had apendicular perforation as intraoperative diagnosis. The average time of hospitalization was 13 days. The total mortality rate was 6%. Conclusions: We conclude that in the elderly population, the duration of disease is significantly greater than in the general population, increasing the likelihood of apendicular perforation; atipic symptoms with respect to those described in patients of different ages, frequent urinary symptoms, lesser prevalence of fever as well as poor contribution of basic laboratory analysis in order to define this disease, could explain this observation. There was no relationship identified between a diagnostic delay and abnormal apendicular localization. (Rev Med Hered 1996; 7: 17-23).

Keywords : Acute appendicitis; elderly; clinical aspects.

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