[Insidious and often fatal. Appendicitis with few symptoms in the elderly patient]

The age peak for acute appendicitis is between 10 and 20 years. Although older persons more rarely develop appendicitis, in the group of over-45-year-olds the perforation and mortality rates are appreciably higher. The reason for this is the fact that in the elderly, the symptoms are often veiled, so that the diagnosis is delayed. A particular role in this connection is played by pain killers and non-specific findings. In particular, however, the commonly present co-morbidity in older patients with appendicitis often leads to recalcitrant infections, and not infrequently to sepsis with a potentially fatal outcome. For the establishment of the diagnosis, therefore, a careful physical examination and thorough history-taking, together with a comprehensive laboratory work-up is essential. Imaging procedures such as X-rays of the abdomen, ultrasonography and, where indicated, such further measures as a barium enema or a CT scan may help establish the diagnosis in patients with unclear clinical symptoms, and thus prevent perforation.