Early Perforation In Appendicitis After Age 60

Twenty-eight consecutive cases of acute appendicitis have been reviewed in patients 60 to 91 years of age. The clinical picture was usually similar but less striking than that seen in young adults. The appendix had perforated in 17 of 21 patients operated upon more than 24 hours after onset of symptoms, but in only one of six patients operated upon before this time. Perforation was frequently correlated with septic complications and was felt to be the chief cause of mortality (2/28, 7%) and complication rate (11/28, 41%). Because of the high incidence of early perforation with acute appendicitis in the elderly, prompt surgical exploration is even more urgent than in younger patients.