Acute Appendicitis in an Elderly Patient: A Case Report

Abstract

Acute appendicitis is one of the most common surgical abdominal emergencies and may lead to severe complications such as perforation if not promptly and appropriately managed, particularly in elderly patients who often present with atypical clinical features. This case report aims to describe the diagnostic approach and management of acute appendicitis in an elderly patient using a comprehensive clinical, laboratory, and imaging-based evaluation. A 64-year-old male presented with right lower quadrant abdominal pain preceded by periumbilical pain, accompanied by nausea and vomiting. Physical examination revealed right lower quadrant tenderness with a positive McBurney sign without generalized peritoneal irritation. Laboratory findings showed leukocytosis with neutrophil predominance, while abdominal ultrasonography suggested acute appendicitis with suspected periappendiceal abscess. Based on the Alvarado and RIPASA scores, the patient was classified as high probability for acute appendicitis and underwent appendectomy. Intraoperative findings revealed non-perforated acute appendicitis without abscess formation, establishing the definitive diagnosis of uncomplicated acute appendicitis. The patient received empirical antibiotic therapy, analgesics, and definitive surgical management with favorable postoperative outcomes without complications. This case highlights that the integration of history taking, physical examination, laboratory tests, imaging, and clinical scoring systems is essential for accurate diagnosis of acute appendicitis, especially in elderly patients with variable clinical presentations, and emphasizes the importance of early surgical intervention to prevent disease progression and complications.