Abdominal surgical emergency in the elderly.

BACKGROUND/AIMS: Longer life expectancy has created an increasing demand for surgical care of the elderly. Abdominal surgical emergencies are potentially serious and life-threatening conditions for this group of patients. The aim of this study was to evaluate the records of elderly patients undergoing emergency surgical treatment.

METHODS

A total of 181 patients aged 60 years and above who had undergone emergency surgical interventions were retrospectively analysed according to demographic features, indications for emergency surgery, postoperative clinical course and outcome.

RESULTS

Sixty-one percent of the patients were male, with an average age of 70.3 (range 60-95) years. Octogenarians constituted 19% of our series. Causes of surgical emergency were acute cholecystitis (31.5%), strangulated hernia (18.2%), hollow viscus perforation (17.1%), bowel obstruction (10.5%), acute mesenteric ischaemia (9.4%), acute appendicitis (8.3%) and upper gastrointestinal haemorrhage (5%). Gallstones had been previously detected by ultrasound in 25 (45.5%) of 55 patients with acute calculous cholecystitis. Thirty (93.8%) of 32 patients were aware of their external hernias prior to incarceration. Twenty seven patients (14.4%) died in the early postoperative period, with acute mesenteric vascular occlusion being the leading cause of death: A higher mortality rate was noted in mesenteric ischaemia (76.5%), gastrointestinal bleeding (22.2%) and in perforation (19.4%) cases, being 36.8% (21/57) in patients with these three severe conditions and 4.8% (6/124) in the remaining patients.

CONCLUSIONS

Acute calculous cholecystitis and external strangulated hernias, which are generally preventable, were the most common surgical emergencies. Surgical treatment of acute mesenteric ischaemia, gastrointestinal haemorrhage and peritonitis secondary to free perforation had a worse prognosis in older patients.