# Atypical Presentation and Diagnostic Challenges of Appendicitis in an 85-Year-Old Male: A Case Report

## TL;DR

An 85-year-old man with unusual symptoms of appendicitis highlights the diagnostic challenges in elderly patients and the importance of using CT scans for accurate diagnosis.

## Contribution

The case emphasizes the atypical presentation of appendicitis in the elderly and the value of early CT scans for diagnosis.

## Key findings

- Elderly patients may present with non-specific symptoms like abdominal pain and nausea, complicating appendicitis diagnosis.
- Contrast-enhanced CT scans proved critical in identifying a perforated appendix after initial misdiagnosis.
- Conservative treatment led to improvement in the patient's condition following accurate diagnosis.

## Abstract

Acute appendicitis in elderly individuals is uncommon and poses a significant challenge due to atypical symptomatology. An 85-year-old male presented to the emergency department (ED) with abdominal pain associated with nausea and reduced oral intake. Physical examination revealed diffuse abdominal tenderness. He was initially treated for constipation with an enema and discharged. Two days later, the patient returned with worsened pain and a new onset of fever. Examination revealed guarding. Lab results showed significant elevation in C-reactive protein (CRP) and white blood count (WBC). A contrast-enhanced computed tomography (CT) scan showed evidence of a perforated appendix. He was admitted into the surgical ward and improved on conservative treatment.

This case describes an atypical presentation of acute appendicitis in an elderly patient, emphasizing the importance of recognizing unusual presentations in this population. Early use of contrast-enhanced CT scans is crucial for accurate diagnosis and improving patients outcomes.