PURPOSE: Surgeons are confronted frequently with the diagnostic and therapeutic challenges in the cases of acute appendicitis in the elderly. Despite the improvements in management, the morbidity and mortality remain high. In order to verify contributing factors of high morbidity and mortality and establish more proper diagnostic and therapeutic strategies, we compared the clinical characteristics and outcomes of acute appendicitis in the elderly with those of younger people. METHODS: We retrospectively reviewed medical records of 30 elderly and 248 younger people who were pathologically diagnosed as appendicitis after an appendectomy. RESULTS: There was no difference in the rates of occurrence of right lower abdominal pain and tenderness between the two people. The rate of appendiceal perforation was significantly higher in the elderly. Prehospital delay was significantly longer in the elderly. Concomitant diseases were more prevalent in the elderly. The hospital stay was significantly longer and the rate of complication was relatively higher in the elderly also. CONCLUSIONS: When a vague and unexplained abdominal discomfort occurs in the elderly, we should suspect and rule out acute appendicitis as the cause of the discomfort. Early aggressive diagnostic and therapeutic interventions are essential components in managing acute appendicitis in the elderly. In addition, perioperative evaluation and prophylactic measures for concomitant diseases are needed to decrease morbidity and mortality in the elderly.
Abdomen, Acute ; Abdominal Pain ; Aged* ; Appendectomy ; Appendicitis* ; Humans ; Length of Stay ; Medical Records ; Mortality ; Retrospective Studies

Tsutsugamushi disease is an acute febrile illness caused by Orientia tsutsugamushi. It is characterized by fever, myalgia, lymphadenopathy, and rash. And it can be easily diagnosed by characteristic eschar and serologic testing. Nearly all of the patients with tsutsugamushi disease improve with antibiotics such as doxycycline. However, the fatality rate of untreated cases is seven to ten percent. The well-known causes of mortality are respiratory failure associated with pulmonary edema or adult respiratory distress syndrome. We report a case of tsutsugamushi disease complicated with acute respiratory distress syndrome and disseminated intravascular coagulopathy, despite of doxycycline treatment. A 78-year old woman was admitted to the hospital because of fever. Twelve days before admission she had suffered myalgia and some days later she developed a rash. Despite of management at a local clinic, her condition deteriorated and she was transferred to our hospital. On admission she presented with altered consciousness and two eschars on her right arm and right thigh. Under the initial diagnosis of scrub typhus, doxycycline was administered. Her fever subsided with the initiation of doxycycline. However, her hypoxia worsened progressively and she died on the fifth hospital day.
Adult* ; Aged ; Anoxia ; Anti-Bacterial Agents ; Arm ; Consciousness ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Fever ; Humans ; Lymphatic Diseases ; Mortality ; Myalgia ; Orientia tsutsugamushi ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Scrub Typhus* ; Serologic Tests ; Thigh