Early Perforation in Appendicitis After Age 60

Coran, Arnold G.

doi:10.1001/jama.1966.03110100053012

Cited by 9 publications

(2 citation statements)

References 6 publications

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“…15 Delay because of atypical presentation and age-related differences in the progression of the inflammation have been proposed as explanations. 16 These explanations have been challenged by recent studies. Redmond found the same rate of progression to perforation in the elderly as in the younger patients.…”

Section: Influence Of Agementioning

confidence: 99%

“…The proportion of perforations has a J‐shaped relation to age, with a high proportion in older people 15. Delay because of atypical presentation and age‐related differences in the progression of the inflammation have been proposed as explanations 16. These explanations have been challenged by recent studies.…”

Section: What Determines the Proportion Of Perforations?mentioning

confidence: 99%

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The Natural History and Traditional Management of Appendicitis Revisited: Spontaneous Resolution and Predominance of Prehospital Perforations Imply That a Correct Diagnosis is More Important Than an Early Diagnosis

2006

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Evidence suggests that spontaneous resolution of untreated, non-perforated appendicitis is common and that perforation can rarely be prevented and is associated with a lower increase in mortality than was previously thought. This motivates a shift in focus from the prevention of perforation to the early detection and treatment of advanced appendicitis. In order to minimize mortality, morbidity and costs avoidance of negative appendectomies is more important then preventing perforation. In patients with an equivocal diagnosis where advanced appendicitis is deemed less likely a correct diagnosis is more important than a rapid diagnosis. These patients can safely be managed by active observation with an improved diagnostic work-up under observation, which has consistently shown a low proportion of negative appendectomies without an increase in the proportion of perforations or morbidity. A high proportion of perforations can be explained by selection due to undiagnosed resolving appendicitis. The proportion of perforation is therefore a questionable measure of the quality of the management of patients with suspected appendicitis and should be used with caution.

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Section: Influence Of Agementioning

confidence: 99%

Section: What Determines the Proportion Of Perforations?mentioning

confidence: 99%