Clinical features of acute appendicitis in the elderly

The clinical features of acute appendicitis in the elderly are masked by:

• laxity of the abdominal musculature and hence late or non-development of rigidity
• typically slower presentation of other classical symptoms
• delayed presentation because pain is ascribed by patient to constipation and laxatives are taken instead
• similarity of presentation to intestinal obstruction, which is more common in this age group; enemas prescribed for obstruction may enhance peritonitis

Consequently, elderly patients with acute appendicitis tend to present later in the course of the illness and have a worse prognosis.