US can often diagnose an inflamed appendix and detects free fluid in the pelvis but this simple method is influenced by the operator’s ACY-738 experience, the body built and co-operation of the patient. The wider use of CT scan for patients with suspected appendicitis has been shown to improve the accuracy of the diagnosis and decrease the negative laparotomy rates [3, 4, 17]. Recent studies reported a high sensitivity of 91-99% in this age group [20]. find more Storm-Dickerson TL et al. reported that the incidence of

perforation declined over the past 20 years from 72% to 51% in his patients due to the earlier use of CT scan [4]. In our patients, CT scan was only used in those with equivocal findings and in whom the diagnosis was not reached after repeated CA and US. We could not calculate the sensitivity and specificity of CA, US and CT scans in our patients because we studied the positive cases. 4SC-202 molecular weight However, we did not find any false positive result when the CT scan was used. Elderly patients have a higher risk for both mortality and morbidity following appendectomy. It was estimated to be around 70% as compared to 1% in the general population [1, 4, 9–11]. In our study, the overall post operative complication rate was 21%, a figure which is a bit lower than 27-60% reported by others [6, 20, 29]. As expected, complications were

three times more frequent in the perforated as compared to the nonperforated group. This finding is in consistency with several other studies that

have shown that perforation per se was the most predictive factor for post operative morbidity in the elderly patients with BCKDHA acute appendicitis [1, 7, 14, 20]. The mortality rate in elderly patients following perforated appendicitis was reported between 2.3%-10%. Death is often related to septic complications compounded by the patient’s co morbidities [3, 6, 7, 29, 30]. In this study, there were 6 (3%) deaths in both groups, four in the perforated and two in the nonperforated group. Three patients died due to septic complications while the others due to respiratory and cardiovascular causes. As compared to younger age groups, the length of the hospital stay is usually longer in the elderly patients. This is usually ascribed to the higher rate of complications, prolonged need of antibiotics, treatment of other comorbidities and difficulties in communication [6, 16, 31]. Our result of 7.4 and 4.2 days for perforated and nonperforated groups was found in agreement with these studies. When comparing our result to a previous study that was done in the same region 10 years back [32], we found that the incidence of appendiceal perforation did not decrease over the past ten years in spite of improved health care programs and diagnostic facilities. We think that this failure was due to the underestimation of the seriousness of the abdominal pain in this age group by both the patients and the primary health care providers.