An 80-year-old man presents with vague abdominal discomfort, mild anorexia, and low-grade fever for 3 days. Examination shows minimal right iliac fossa tenderness and a temperature of 37.6 degrees Celsius. WBC is 13,500 per microlitre. Compared with a young adult with the same disease, which feature best explains the risk in this patient?

• A Lower incidence of perforation because of a fibrotic, scarred appendix
• B Higher incidence of perforation due to delayed diagnosis and atypical presentation ✓
• C Uniformly higher leucocyte count leading to earlier diagnosis
• D Predominance of right upper quadrant pain from a subhepatic appendix

Explanation

Elderly patients have an atypical, blunted presentation: pain may be vague, fever and tachycardia are modest, and tenderness is often poorly localised, so diagnosis is delayed. Because the disease has usually progressed further by the time of surgery, the perforation rate in the elderly is substantially higher than in young adults. B high leucocyte count is not typical, and a subhepatic appendix is a positional variant unrelated to age.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.