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[Acute appendicitis in patients over 70 years of age].

OBJECTIVES
We assessed preoperative diagnosis of appendicitis and perforations in elderly patients in our unit to determine whether the overall higher rate of appendectomy in France (3 to 4 times higher than in anglo-saxon countries) has an effect.


METHODS
We analyzed retrospectively the cases of all patients over 70 years of age who undervent appendectomy for histologically confirmed appendicitis between February 1, 1990 and 31 January 1995.


RESULTS
There were 20 patients (15 women 5 men) in the study group (age range 70-89 years). The site of abdominal pain was atypical in 10 cases (50%) and acute bowel occlusion occurred in 9 (45%). The diagnosis of appendicitis was made before surgery in 10 patients; surgery was performed within 24 hours of admission in only 8. The high rate of perforations (70%) was not correlated with age. Complications occurred in 70% of the cases and were related to perforation (p < 0.02) and an American Society of Anesthesia (ASA) score > 2 (p < 0.05).


CONCLUSION
Acute appendicitis in the elderly patient is a serious condition. The atypical nature of the clinical presentation in half of the patients often requires computed tomography or laparoscopy for diagnosis.