Differential diagnosis in the elderly

Appendicitis is a grave concern in the elderly patient. Poorer localisation of infection and diminished blood supply to the appendix result in a relatively greater incidence of gangrene and perforation at operation than in other groups.

The differential diagnosis is wider than younger individuals and includes:

• intrabdominally:
  • perforated peptic ulcer
  • acute cholecystitis
  • acute intestinal obstruction
  • gastroenteritis
  • acute diverticulitis
  • acute regional ileitis
    
    
• urinary tract:
  • renal colic
  • pyelonephritis
    
    
• chest:
  • basal pneumonia
  • pleurisy
  • rarely, myocardial infarction
    
    
• miscellaneous:
  • abdominal pain before a paroxysm of herpes zoster
  • diabetes

Elderly individuals may be more stoical and less willing to report symptoms; this inevitably delays treatment.