Department of General Surgery and Urology, King Abdullah University Hospital, Jordan University of Science and Technology, 22110 Irbid, Jordan.
World J Emerg Surg. 2014 Jan 15;9(1):6. doi: 10.1186/1749-7922-9-6.
Acute appendicitis is the most common surgical emergency and becomes serious when it perforates. Perforation is more frequent in the elderly patients. The aim of this study was to identify the risk factors of perforation in elderly patients who presented with acute appendicitis.
The medical records of 214 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis over a period of 10 years (2003-2013) were retrospectively reviewed. Patients were grouped into those with perforated and those with nonperforated appendicitis. Comparison was made between both groups in regard to demography, clinical presentation, and time delay to surgery, diagnosis, hospital stay and postoperative complications. Clinical assessment, Ultrasonography and Computerized tomography, in that order, were used for diagnosis. The incidence of perforation was also compared with a previous report from the same region 10 years earlier.
During the study period, a total of 214 patients over the age of 60 years had acute appendicitis, 103 males and 111 females. Appendix was found perforated in 87 (41%) patients, 46 (53%) males and 41 (47%) females. Of all patients, 31% were diagnosed by clinical assessment alone, 40% needed US and 29% CT scan. Of all the risk factors studied, the patient's pre-hospital time delay was the most important risk factor for perforation. Perforation rate was not dependent on the presence of comorbid diseases or in-hospital time delay. Post operative complications occurred in 44 (21%) patients and they were three times more common in the perforated group, 33 (75%) patients in the perforated and 11 (25%) in the nonperforated group. There were 6 deaths (3%), 4 in the perforated and 2 in the nonperforated group.
Acute appendicitis in elderly patients is a serious disease that requires early diagnosis and treatment. Appendiceal Perforation increases both mortality and morbidity. All elderly patients presented to the hospital with abdominal pain should be admitted and investigated. The early use of CT scan can cut short the way to the appropriate treatment.
急性阑尾炎是最常见的外科急症，当它穿孔时会变得很严重。穿孔在老年患者中更为常见。本研究的目的是确定老年急性阑尾炎患者穿孔的危险因素。
回顾性分析了 2003 年至 2013 年间 214 名年龄在 60 岁以上、经病理证实为急性阑尾炎的患者的病历。患者分为穿孔组和非穿孔组。比较两组患者的人口统计学、临床表现、手术时间延迟、诊断、住院时间和术后并发症。临床评估、超声检查和计算机断层扫描依次用于诊断。还将穿孔的发生率与 10 年前同一地区的一份报告进行了比较。
研究期间，共有 214 名年龄在 60 岁以上的急性阑尾炎患者，其中男性 103 例，女性 111 例。阑尾穿孔 87 例（41%），男性 46 例（53%），女性 41 例（47%）。所有患者中，31%仅通过临床评估诊断，40%需要 US，29%需要 CT 扫描。在所有研究的危险因素中，患者的院前时间延迟是穿孔的最重要危险因素。穿孔率与合并症或住院时间延迟无关。术后并发症发生在 44 例（21%）患者中，穿孔组并发症发生率为 3 倍，穿孔组 33 例（75%），非穿孔组 11 例（25%）。死亡 6 例（3%），穿孔组 4 例，非穿孔组 2 例。
老年急性阑尾炎是一种严重的疾病，需要早期诊断和治疗。阑尾穿孔增加了死亡率和发病率。所有因腹痛就诊的老年患者均应住院并接受检查。早期使用 CT 扫描可以缩短治疗途径。
