Special Considerations

Elderly Patients with Abdominal Pain

Elderly patients presenting with abdominal complaints warrant a complete evaluation.

  • Up to 50% of those over 65 yr of age will ultimately have a process evolving that requires medical or surgical intervention. Therefore, it is judicious to check laboratory and imaging studies.
  • While physical examination is important, elderly patients frequently present atypically. They will often lack fever and leukocytosis. For instance, it is well documented that elderly patients will have perforated appendicitis at an early time and with a less obvious exam, than their younger counterparts. Higher morbidity and mortality from higher rates appendiceal perforation is the rule. After 50 yr of age perforation rates are from 32-70%.
    Delays in the diagnosis are typically due to:
    • Atypical presentations
    • Anatomy
      • Less blood supply to appendix most likely
      • One-third of perforations are in those with symptoms < 24 h.
Additionally, the risk of solid masses increases as does the presence of intra-abdominal infections. Elderly patients often will lack vital sign abnormalities. They may have hemoperitoneum with normal vital signs.
       
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