[Acute appendicitis in patients under 5 and over 60 years of age]

The authors reviewed the records of 48 patients, 24 under age 5 and 24 over age 60, from a total of 690 patients who underwent emergency appendectomy for acute appendicitis between 1974 and 1989. The natural history of acute appendicitis was similar for the two groups. A perforated appendix was found in 20.8% of patients under age 5 and in 37.5% of patients over age 60; the corresponding rate for the total of 690 patients was 12.8%. The high percentage of perforation, when compared to the total of patients, is probably due to the thin wall of the appendix in infants and to the inability of the child to communicate the effective symptoms. As for the elderly, a reduction of the lymphoid and muscular tissues associated with a reduced lumen and vascularization of the organ, and at last, a delay in seeking medical care could account for the high perforation rate. The most common complications were due to infection. The mortality rate was 0% in children and 8.3% in the over-sixty age group.