Introduction:
The human gastrointestinal tract is several meters long and divided into several parts. Parts like the esophagus, stomach, small intestine, and large intestine play an important role in digestion. Apart from these, the gastrointestinal tract comprises several organs and glands. The appendix is one such organ of the human gastrointestinal tract. However, according to researchers, the appendix has become useless over time due to evolutionary processes. In mammals, the appendix helps in digestion. Due to changes in lifestyle and food habits, the appendix has become a vestigial organ in humans. However, according to some researchers, it plays a vital role in maintaining the microbial population in the gut. The inflammation of the appendix is known as appendicitis. It is a common surgical complication seen in young adults. Almost 13 percent of the young adult population in the world is affected by this complication. However, the incidence of such inflammation in elderly people ranges from seven to ten percent.
What Is Appendicitis?
The appendix is located in the large intestine at the end of the cecum. It is a pouch-like portion where the small intestine empties its contents. The appendix is connected to the ileocecal junction through the ileocecal fold, also known as the bloodless fold of Treves. This peritoneal structure originates from the antimesenteric aspect of the ileum, extends over the ileocecal junction, and merges with the base of the mesoappendix. The average length of the appendix is 3.5 inches, and the diameter is 2 to 13.8 inches. During inflammation, the size of the appendix is increased. The joining portion of the appendix and cecum is relatively narrow. Moreover, the appendix possesses strong muscular walls that can typically push out the mucus secretions from the walls of the appendix or any intestinal contents that have entered the structure into the cecum. The appendix is rich in lymphatic supply and contains a large number of lymphatic tissues.
The inflammation of the appendix is known as appendicitis. The obstruction of the appendiceal lumen causes this inflammation. Such obstructions are mainly caused either by appendicolith, stone in the appendix, or mechanical obstruction. In some cases, tumors like carcinoid tumors (a slow-growing cancerous tumor) and appendiceal adenocarcinoma (epithelial cancer of the lining of the appendix) may cause this type of infection. Apart from this, intestinal parasites and hypertrophied lymphatic tissues may cause such obstructions. These obstructions and infections cause inflammation, as shown in the appendix. This inflammation further causes abscess formation and rupture of the tissue. As a result, pus, inflammatory, and infectious substances spread to the other portions of the body.
What Is Appendicitis in the Elderly?
The incidence of elderly appendicitis was relatively low. However, the prevalence of such conditions is increasing day by day. Also, the associated risk factors related to elderly appendicitis are much higher than those of young ones. The mortality rate associated with elderly appendicitis is much higher. Also, the incidence of complications such as perforation of the appendix due to infection is higher than in young individuals. The risk factors associated with such complications are mainly related to the presence of comorbid conditions. The presence of disorders like hypertension, diabetes, renal disorders, and heart disorders.
What Are the Symptoms of Appendicitis in the Elderly?
The clinical symptoms associated with the elderly appendicitis are;
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Pain in the lower abdominal region is the most common symptom. Patients often complain of sharp and severe pain at night, which causes loss of sleep. Patients experience pain while walking and coughing. In the initial phase, the pain may refer to the right iliac fossa (the right lowermost portion of the abdomen). However, later, the pain becomes localized.
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Patients often complain of loss of appetite and heaviness in the abdomen.
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Patients give a history of urgency in urination and frequent defecation with diarrhea-like symptoms.
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Other symptoms like fever and vomiting are present.
The medical professional must examine the patient before going to medical evaluations. In the examination, the following details are noted;
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Pain in McBurney's point ( a point locating the base of the abdomen) can be noted.
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Other clinical signs like psoas sign (pain in the passive extension of the right hip) and obturator sign (pain during internal rotation of the right hip) can be noted. These symptoms help to differentiate between different clinical conditions like retro cecal appendicitis and pelvic appendicitis.
In the laboratory evaluation, elevated levels of white blood cells are noted. Abnormalities in the imaging analysis, such as computed tomography and ultrasonography, reveal an increase in the size of the appendix. In some cases, calcified appendicolith can be observed. Based on the above information, appendices can be categorized into complicated and uncomplicated appendicitis. In cases of complicated appendicitis, complications like necrosis of the tissues, perforations, and abdominal abscess formation can be observed.
What Are the Treatment Options?
Application of antibiotics along with surgical removal of the appendix is the most common and suitable treatment option. In cases like an abscess in the appendix, antibiotics are prescribed for a few weeks before elective removal of the appendix. The surgical removal of the appendix can be done either by open method or by laparoscopic method. The laparoscopic approach is widely accepted and popular due to less incidence of hospitalization, quick recovery, and fewer chances of post-operative complications. However, some surgeons prefer open surgical interventions over a laparoscopic approach in complicated cases. Complicated appendicitis cases can be managed in a better way through surgical approaches. Also, older individuals with comorbid conditions may not be suitable for the laparoscopic approach. Also, in cases of older individuals, more aggressive surgical approaches such as ileocecal resection and right-sided hemicolectomy are needed.
Elderly individuals are more susceptible to post-operative complications. The duration of the hospital stay after surgery is higher in older individuals. Post-operative infections are very common in elderly individuals. Diffuse peritonitis and sepsis can occur due to reduced immunity in older individuals. Also, complications such as abscesses, hematomas, and delayed wound healing are noted in elderly patients.
Conclusion:
Appendicitis is a common infection of the gastrointestinal tract. Though its prevalence among elderly people is less than the young ones, it may cause serious complications. Due to the presence of comorbid conditions, appendicitis may cause serious complications to the elderly. Also, aging may be associated with delayed recovery in such cases.
