Acute Appendicitis in the Elderly: Hidden Dangers and Diagnostic Challenges

Acute appendicitis is a common surgical emergency, yet its presentation in elderly patients over 65 differs significantly from that in younger adults. Often termed an "atypical" or "silent" pathology, it poses severe risks due to delayed diagnosis.
Why is it dangerous? In older adults, physiological changes such as reduced nerve sensitivity and weakened immune responses mask classic symptoms. The pain is often dull rather than acute. Consequently, perforation and rupture occur more frequently before hospitalization. This leads to diffuse peritonitis, sepsis, and systemic inflammatory response syndrome (SIRS), resulting in mortality rates several times higher than in young patients.
Atypical Symptoms The classic triad of right lower quadrant pain, fever, and vomiting is absent in many seniors. Instead, look for:

• General weakness, lethargy, or confusion;
• Loss of appetite (anorexia);
• Mild abdominal distension;
• Changes in bowel habits. Caregivers must avoid self-medication with painkillers, as they further obscure the clinical picture for surgeons.

Treatment Features Management requires a delicate balance. Laparoscopic appendectomy is preferred to minimize tissue trauma. However, if perforation has occurred, open surgery may be necessary. Post-operative care is critical: antibiotic therapy is prolonged, sutures are typically removed on days 12–14, and early mobilization is essential to prevent pneumonia and thrombosis.
If you suspect appendicitis in an elderly relative, seek immediate medical attention. In geriatrics, any unexplained abdominal pain should be treated as a potential surgical emergency until proven otherwise.