Right Iliac Fossa Pain in Elderly Patients

Introduction Right iliac fossa (RIF) pain is a common emergency presentention to the hospital. Appendicitis is often thought of as a disease of the young but it has now become a disease of the elderly because of increasing life expectancy of the modern-day man resulting from improved medical attention. It is the most common cause of acute surgical condition of the abdomen. Aim The aim of this study was to investigate the incidence and variety of causes for right-sided lower abdominal pain in the population aged over 50 years. Method: All patients admitted to the general surgery department in Bucharest Emergency Hospital between January 2014 and September 2017 were identified, yielding a total of 146 patients with right iliac fossa pain aged over 50 years old. Results One hundred forty-six patients were studied aged over 50 years old admitted for right iliac fossa pain in emergency setting. Dividing the cases by year we noticed that the number of the patients admitted were roughly equal, with a low incidence in 2014 (only 31 cases). Out of 146 cases, the proportion of male: female was approximately equal, and at 98 patients (67%) abdominal CT was performed before surgery or discharging. Ninety-two of 146 (63%) patients underwent surgery. Half of this patients (52.05%) were diagnosed with acute appendicitis in different histopathological varaints. Second was non-specific abdominal pain in wich nothing was found in investigations, and the pain was disappeared after medical treatment. Colonic neoplasia was found only in 8 patients (5.5%). For 21 patients diagnosed with appendicitis in CT, laparoscopic appendectomy was performed, and in 3 cases conversion to open surgery was chosen because massive inflammation, and unclear anatomy. Conclusion Clinicians should be aware that appendicitis remains an important differential diagnosis in elderly adults with abdominal pain or unspecific symptoms localized in right iliac fossa, and performing preoperative abdminal CT should help surgeon to define the surgery approach.