ZenToks Publication

Chapter 8

The Management of Acute Appendicitis in The Elderly: A Review

Abstract/Preface

Acute appendicitis continues to be a prevalent surgical emergency globally; however, its presentation, diagnosis, and management in elderly patients differ significantly from those in younger cohorts. Elderly patients often display atypical clinical symptoms, delayed presentation, multiple comorbidities, and diminished physiological reserve, factors that contribute to increased rates of perforation, postoperative complications, extended hospitalization, and mortality. Advances in diagnostic imaging, minimally invasive surgery, perioperative care, and risk stratification have markedly enhanced outcomes in this demographic. The role of non-operative management with antibiotics remains contentious, particularly due to concerns about recurrence, undetected neoplasms, and delayed definitive treatment. This review evaluates current evidence concerning treatment options and outcomes for acute appendicitis in the elderly, with a focus on the roles of non-operative treatment and appendectomy. Additionally, the role of laparoscopic appendectomy in managing acute appendicitis in the elderly is examined. Understanding the distinct characteristics of appendicitis in elderly patients is crucial for enhancing diagnostic accuracy, minimizing complications, and optimizing clinical outcomes.