Non-traumatic surgical abdominal emergency in the elderly

ABSTRACT

The most frequent surgical problem in the elderly patients is the abdominal surgical emergency, which is potentially serious, considerable challenge and a life threatening condition in this populations. The higher incidence of serious pathology in this age group, increasing demand for surgical emergency care to save life and increase its expectancy. The aim of this study was to evaluate the causes and the outcome of non-traumatic surgical abdominal emergencies in elderly patients. A total of 150 patients aged 60 years and above, with a mean age of 68.3 [range 60-84] years who had undergone emergency surgical interventions studied, as regards, the demographic features the indications for emergency surgery the post-operative clinical course and the outcome of surgery. Sixty percent [90/l 50] of patients were males. Causes of surgical emergency were acute cholecystitis 39/150 [26%], strangulated hernia 30/l50 [20%], hollow viscus perforation 27/150 [18%], bowel obstruction 18/150 [12%], acute mesenteric ischaemia l4/150 [9.3%], acute appendicitis 12/150 [8%] and upper gastrointestinal bleeding 10/l50 [6.6%]. Gallstones had been previously detected by ultrasound in 16 [4 1%] of 39 patients with acute calculous cholecystitis. Twenty eight [93.3%] of 30 patients were aware of their external hernias prior to incarceration. Twenty one patients 21/150 [14%] died in the early postoperative period. A higher mortality rate was noted in acute mesenteric ischaemia 11/14 [78.5%], gastrointestinal bleeding 3/10 [30%] and in perforation 4/27 [14.8%] cases, being 35.3% [18/51] in patients with these three severe conditions, and 3.03% [3/99] in the remaining patients. So, we conclude that the acute calcular cholecystitis and external strangulated hernias, which are generally preventable, were the most common surgical emergencies. Surgical treatment of acute mesenteric ischaemia, gastrointestinal bleeding and peritonitis secondary to free perforation had a worse prognosis in older patients