Management of Non-Traumatic Acute Abdominal Pain in Elderly Patients
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OBJECTIVE. The aim of this study is to evaluate the effects of physiological changes in elderly patients in management of non-traumatic acute abdominal pain.
MATERIALS AND METHODS. After ethical approval, in the study, 50 patients were included and they were admitted in ED of Al- Hussein teaching hospital in Al-Nasiriya city South of Iraq. Patients age was range between 65 to 80s years, the chief complaint was abdominal pain and they present to hospital between April 2017 - August 2017. The patients were divided into two subgroups, group A (65–74 years) and B (> 75 years).
Inclusion criteria include non-traumatic abdominal pain patients older than 65 years.
Exclusion criteria: patients less than 65 years old and those with traumatic abdominal pain.
RESULTS. From 50 old age patients were admitted to the ED the total number and percentage of patient underwent surgery were 18 patients (36%)15 patients from group A (old age patients) (37.5%) while 3 elderly patients (30 %) from group B. The operations that were done in group A 2 patients for perforated peptic ulcer, 4 appendectomies, 4 cholecystectomies, 3 for surgical management of intestinal obstruction due to tumor and 5 operations for management of obstructed hernia, while other patients were treated conservatively.
The percentage of non –malignant intestinal obstruction was 83.3% (18 patients).
CONCLUSION. Physiological changes related to aging process with comorbidities have adverse effects in clinical findings and making difficultly or delay in diagnosis of acute abdominal pain in elderly patient, so it is important to strictly adherence to guide lines in management of acute abdominal pain in geriatric patients.
Weinandt, M., Godiris-Petit, G., Menegaux, F., Chereau, N., & Lupinacci, R. M. (2020). Appendicitis is a severe disease in elderly patients: a twenty-year audit. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons, 24(3).
Ouchi, Y., Rakugi, H., Arai, H., Akishita, M., Ito, H., Toba, K., & Kai, I. (2017). Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int, 17(7), 1045-1047.
Orimo, H., Ito, H., Suzuki, T., Araki, A., Hosoi, T., & Sawabe, M. (2006). Reviewing the definition of “elderly”. Geriatrics & gerontology international, 6(3), 149-158.
Baek, H. N., Jung, Y. H., & Hwang, Y. H. (2011). Laparoscopic versus open appendectomy for appendicitis in elderly patients. Journal of the Korean society of Coloproctology, 27(5), 241.
Omari, A. H., Khammash, M. R., Qasaimeh, G. R., Shammari, A. K., Yaseen, M. K. B., & Hammori, S. K. (2014). Acute appendicitis in the elderly: risk factors for perforation. World Journal of Emergency Surgery, 9, 1-6.
Shin, D. H., Cho, Y. S., Kim, Y. S., Ahn, H. C., Oh, Y. T., Park, S. O., ... & Lee, Y. H. (2018). Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly. Journal of Clinical Laboratory Analysis, 32(1), e22177.
Dhillon, N. K., Barmparas, G., Lin, T. L., Alban, R. F., Melo, N., Yang, A. R., ... & Ley, E. J. (2019). Unexpected complicated appendicitis in the elderly diagnosed with acute appendicitis. The American Journal of Surgery, 218(6), 1219-1222.
Harbrecht, B. G., Franklin, G. A., Miller, F. B., Smith, J. W., & Richardson, J. D. (2011). Acute appendicitis—not just for the young. The American journal of surgery, 202(3), 286-290.
Lapsa, S., Ozolins, A., Strumfa, I., & Gardovskis, J. (2021). Acute appendicitis in the elderly: a literature review on an increasingly frequent surgical problem. Geriatrics, 6(3), 93.
Jazwinski, S. M., & Kim, S. (2019). Examination of the dimensions of biological age. Frontiers in genetics, 10, 263.
Maltoni, R., Ravaioli, S., Bronte, G., Mazza, M., Cerchione, C., Massa, I., ... & Bravaccini, S. (2022). Chronological age or biological age: What drives the choice of adjuvant treatment in elderly breast cancer patients?. Translational Oncology, 15(1), 101300.
Basaraba, S. (2023). Chronological vs. Biological Age: Understanding the Differences and Factors That Affect Your Health. Verywell health.
Ciccarone, F., Tagliatesta, S., Caiafa, P., & Zampieri, M. (2018). DNA methylation dynamics in aging: how far are we from understanding the mechanisms? Mechanisms of ageing and development, 174, 3-17.
Mundstock, E., Sarria, E. E., Zatti, H., Mattos Louzada, F., Kich Grun, L., Herbert Jones, M., ... & Mattiello, R. (2015). Effect of obesity on telomere length: systematic review and meta‐analysis. Obesity, 23(11), 2165-2174.
Huzen, J., Wong, L. S. M., Van Veldhuisen, D. J., Samani, N. J., Zwinderman, A. H., Codd, V., ... & Van Der Harst, P. (2014). Telomere length loss due to smoking and metabolic traits. Journal of internal medicine, 275(2), 155-163.
Tang, L., Tian, Y., Li, D., Ma, Y., & Wang, J. Residential Greenness, Genetic Susceptibility and Telomere Length in Elderly Population: Findings from UK Biobank. Genetic Susceptibility and Telomere Length in Elderly Population: Findings from UK Biobank.
Verki, M. M., & Motamed, H. (2018). Rectus muscle hematoma as a rare differential diagnosis of acute abdomen; a case report. Emergency, 6(1)
Karunarathna, I., Disanayake, D. D., Kurukulasooriya, P., Wickramarachchi, N., Rangana, P., Rathnayake, B., ... & Samarasinghe, A. Comprehensive Management of Acute Abdomen: Strategies for Rapid Diagnosis and Multidisciplinary Care.
Kaushal-Deep, S. M., Anees, A., Khan, S., Khan, M. A., & Lodhi, M. (2018). Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature. International Journal of Critical Illness and Injury Science, 8(2), 90-99.
de Burlet, K., Lam, A., Larsen, P., & Dennett, E. (2017). Acute abdominal pain-changes in the way we assess it over a decade. The New Zealand Medical Journal (Online), 130(1463), 39-44.
Logoglu, A., Ayrik, C., Kose, A., Bozkurt, S., Demir, F., Narci, H., & Karaaslan, U. (2013). Analysis of non-traumatic elderly patient presentations to the emergency department/Acil servise basvuran travma disi geriatrik olgularin demografik ozelliklerinin incelenmesi. Turkish Journal of Emergency Medicine, 13(4), 171-180.
Demircan, A., BIKMAZ, Ş. G. A., Kadi, G. Ü. L. T. E. K. İ. N., Keleş, A. Y. F. E. R., Bildik, F., Öktem, B., & Cakmak, O. (2017). Evaluation of the general characteristics of patients aged 85 years and above admitted to a university hospital emergency department. Turkish Journal of Medical Sciences, 47(5), 1393-1402.
Keskinoğlu, P., & İnan, F. (2014). Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey. Journal of Clinical Gerontology and Geriatrics, 5(4), 127-131.
Fagbohun, C. F., Toy, E. C., & Baker III, B. (1999). The evaluation of acute abdominal pain in the elderly patient. Primary Care Update for OB/GYNS, 6(6), 181-185.
McNamara, R. (2004). Abdominal pain in the elderly. Emergency Medicine: a Comprehensive Study Guide. 6th ed. New York: McGraw-Hill, 515-519.
Paranjape, C., Dalia, S., Pan, J., & Horattas, M. (2007). Appendicitis in the elderly: a change in the laparoscopic era. Surgical endoscopy, 21, 777-781.
Murata, A., Okamoto, K., Mayumi, T., Maramatsu, K., & Matsuda, S. (2014). Age-related differences in outcomes and etiologies of acute abdominal pain based on a national administrative database. The Tohoku journal of experimental medicine, 233(1), 9-15.
Parker, J. S., Vukov, L. F., & Wollan, P. C. (1996). Abdominal pain in the elderly: use of temperature and laboratory testing to screen for surgical disease. Family medicine, 28(3), 193-197.
Tran, B. K., Groebli, Y., & Della, S. V. (2012). Abdominal pain among elderly patients in the emergency department. Revue Medicale Suisse, 8(350), 1548-1552.
Lewis, L. M., Banet, G. A., Blanda, M., Hustey, F. M., Meldon, S. W., & Gerson, L. W. (2005). Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(8), 1071-1076.
Pavlidis, T. E., Pavlidis, E. T., Symeonidis, N. G., Psarras, K., & Sakantamis, A. K. (2012). Current curative surgical management of gallbladder cancer: a brief review. Journal of Current Surgery, 2(3), 81-83.
Kapan, M., Onder, A., Polat, S., Aliosmanoglu, I., Arikanoglu, Z., Taskesen, F., & Girgin, S. (2012). Mechanical bowel obstruction and related risk factors on morbidity and mortality. Journal of Current surgery, 2(2), 55-61.
Dent, T. L., & Kukora, J. S. (1995). Benign diseases of the small bowel and colon Benign diseases of the small bowel and colon. General Surgery. Lippincott Company, 275-283.
Kagızman, S. H., Belviranlı, M., Şahin, M., Vatansev, C., Karahan, O., & Alptekin, H. (1997). Clinical analysis of patients operated on due to mechanical intestinal obstruction. J Med Sci, 17, 203-209.
Ripamonti, C. I., Easson, A. M., & Gerdes, H. (2008). Management of malignant bowel obstruction. European Journal of Cancer, 44(8), 1105-1115.
Lynch, B., & Sarazine, J. (2006). A guide to understanding malignant bowel obstruction. International journal of palliative nursing, 12(4), 164-171.
Andersen, P., Jensen, K. K., Erichsen, R., Frøslev, T., Krarup, P. M., Madsen, M. R., ... & Iversen, L. H. (2017). Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection. BJS open, 1(2), 30-38.
Doshi, R., Desai, J., Shah, Y., Decter, D., & Doshi, S. (2018). Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States. Internal and emergency medicine, 13, 881-887.
Everhart, J. E., Khare, M., Hill, M., & Maurer, K. R. (1999). Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology, 117(3), 632-639.
Lirussi, F., Nassuato, G., Passera, D., Toso, S., Zalunardo, B., Monica, F., ... & Okolicsanyi, L. (1999). Gallstone disease in an elderly population: the Silea study. European journal of gastroenterology & hepatology, 11(5), 485-492.
Festi, D., Dormi, A., Capodicasa, S., Staniscia, T., Attili, A. F., Loria, P., ... & Colecchia, A. (2008). Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World journal of gastroenterology: WJG, 14(34), 5282.
Ratner, J., Lisbona, A., Rosenbloom, M., Palayew, M., Szabolcsi, S., & Tupaz, T. (1991). The prevalence of gallstone disease in very old institutionalized persons. Jama, 265(7), 902-903.
Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: the older population in the United States.
Riall, T. S., Zhang, D., Townsend Jr, C. M., Kuo, Y. F., & Goodwin, J. S. (2010). Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. Journal of the American College of Surgeons, 210(5), 668-677.
Wakabayashi, G., Iwashita, Y., Hibi, T., Takada, T., Strasberg, S. M., Asbun, H. J., ... & Yamamoto, M. (2018). Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). Journal of Hepato‐biliary‐pancreatic Sciences, 25(1), 73-86.
Parker, L. J., Vukov, L. F., & Wollan, P. C. (1997). Emergency department evaluation of geriatric patients with acute cholecystitis. Academic emergency medicine, 4(1), 51-55.
Lee, S. W., Yang, S. S., Chang, C. S., & Yeh, H. J. (2009). Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. Journal of gastroenterology and hepatology, 24(12), 1857-1861.
Ladra, M. J., Paredes, J. P., Flores, E., Martínez, L., Rojo, Y., Potel, J., & Beiras, A. (2009). Laparoscopic cholecystectomy in patients aged 80 and over. Cirugía Española (English Edition), 85(1), 26-31.
Yetkin, G., Uludag, M., Oba, S., Citgez, B., & Paksoy, I. (2009). Laparoscopic cholecystectomy in elderly patients. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 13(4), 587.
Stewart, B. W. K. P., Khanduri, P., McCord, C., Ohene-Yeboah, M., Uranues, S., Vega Rivera, F., & Mock, C. (2014). Global disease burden of conditions requiring emergency surgery. Journal of British Surgery, 101(1), e9-e22.
Ferris, M., Quan, S., Kaplan, B. S., Molodecky, N., Ball, C. G., Chernoff, G. W., ... & Kaplan, G. G. (2017). The global incidence of appendicitis: a systematic review of population-based studies. Annals of surgery, 266(2), 237-241.
Kraemer, M., Franke, C., Ohmann, C., Yang, Q., & Acute Abdominal Pain Study Group. (2000). Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature. Langenbeck's archives of surgery, 385, 470-481.
Weinandt, M., Godiris-Petit, G., Menegaux, F., Chereau, N., & Lupinacci, R. M. (2020). Appendicitis is a severe disease in elderly patients: a twenty-year audit. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons, 24(3).
MacKersie, A. B., Lane, M. J., Gerhardt, R. T., Claypool, H. A., Keenan, S., Katz, D. S., & Tucker, J. E. (2005). Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology, 237(1), 114-122.
Horattas, M. C., Guyton, D. P., & Wu, D. (1990). A reappraisal of appendicitis in the elderly. The American Journal of Surgery, 160(3), 291-293.
Smithy, W. B., Wexner, S. D., & Dailey, T. H. (1986). The diagnosis and treatment of acute appendicitis in the aged. Diseases of the colon & rectum, 29(3), 170-173.
Franz, M. G., Norman, J., & Fabri, P. J. (1995). Increased morbidity of appendicitis with advancing age. The American surgeon, 61(1), 40-44. ISO 690
Storm-Dickerson, T. L., & Horattas, M. C. (2003). What have we learned over the past 20 years about appendicitis in the elderly?. The American journal of surgery, 185(3), 198-201.
Omari, A. H., Khammash, M. R., Qasaimeh, G. R., Shammari, A K., Yaseen, M. K. B., & Hammori, S. K. (2014). Acute appendicitis in the elderly: risk factors for perforation. World Journal of Emergency Surgery, 9, 1-6
