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2016, Número 3

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Cir Gen 2016; 38 (3)


Errores en el diagnóstico de apendicitis aguda en ancianos. Estudio de un caso clínico y revisión de la literatura

Herrera CL, Joffe FJ, Llamas PLE

Idioma: Español
Referencias bibliográficas: 41
Paginas: 149-157
Archivo PDF: 404.57 Kb.


RESUMEN

Introducción: Por más de seis décadas, la apendicitis aguda en pacientes longevos continúa teniendo errores diagnósticos, lo que resulta en la demora de un diagnóstico oportuno y un retraso en la cirugía. La apendicitis del anciano se caracteriza por un retardo en el diagnóstico y tratamiento de índole multifactorial. El hallazgo habitual durante la cirugía es un apéndice perforado con peritonitis regional o generalizada. La muerte en estos individuos es secundaria a sepsis abdominal por siembra bacteriana de origen intestinal. El curso postoperatorio en un anciano con un proceso inflamatorio mínimo en el apéndice cecal, como el que se describe, es habitualmente benigno al controlarse oportunamente la contaminación peritoneal. Si una comorbilidad no interviene en el postoperatorio, el egreso hospitalario es rápido. Caso clínico: En el caso que se presenta, el apéndice tuvo un aspecto normal, como se muestra en la fotografía. Nosotros decidimos resecarlo por ausencia de otras anormalidades en la cavidad abdominal. En el estudio histopatológico se describieron cambios inflamatorios confinados a mucosa y submucosa. No hubo perforación. Estas modificaciones pudieron ser secundarias a una severa hipoperfusión por el estado de la mujer. Conclusiones: Resulta peligroso concluir que “aunque macroscópicamente se aprecie normal el apéndice cecal en sujetos longevos, sería muy razonable extirparlo” para evitar un desenlace como el del caso que se presenta.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Peltokallio P, Jauhiainen K. Acute appendicitis in the aged patient. Study of 300 cases after the age of 60. Arch Surg. 1970; 100: 140-143.

  2. Søreide O. Appendicitis —a study of incidence, death rates and consumption of hospital resources. Postgrad Med J. 1984; 60: 341-345.

  3. Horattas MC, Haught R. Managing appendicitis in the elderly patient. AORN J. 1992; 55: 1282-1285.

  4. Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990; 160: 282-285.

  5. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995; 61: 40-44.

  6. Peltokallio P, Tykkä H. Evolution of the age distribution and mortality of acute appendicitis. Arch Surg. 1981; 116: 153-156.

  7. Lau WY, Fan ST, Yiu TF, Chu KW, Lee JM. Acute appendicitis in the elderly. Surg Gynecol Obstet. 1985; 161: 157-160.

  8. Leigh DA, Simmons K, Norman E. Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection. J Clin Pathol. 1974; 27: 997-1000.

  9. Smithy WB, Wexner SD, Dailey TH. The diagnosis and treatment of acute appendicitis in the aged. Dis Colon Rectum. 1986; 29: 170-173.

  10. McCaig LF, Nawar EN. National hospital ambulatory medical care survey: 2004 emergency department summary. Advance date from vital and health statistics. Adv Data. 2006; 372: 1-29.

  11. Wilber ST, Gerson LW, Terrell KM, Carpenter CR, Shah MN, Heard K, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system. Acad Emerg Med. 2006; 13: 1345-1351.

  12. Wofford JL, Schwartz E, Timerding BL, Folmar S, Ellis SD, Messick CH. Emergency department utilization by the elderly: analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med. 1996; 3: 694-699.

  13. McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med. 1992; 212: 796-801.

  14. Coroş MF, Copotoiu C, Copotoiu S, Ioniţă S, Dobre A, Sorlea S, et al. Surgical emergencies in elderly. Chirurgia (Bucur). 2008; 103: 283-290.

  15. De Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol. 1994; 19: 331-335.

  16. Ongrádi J, Stercz B, Kövesdi V, Vértes L. Immunosenescence and vaccination of the elderly II. New strategies to restore age-related immune impairment. Acta Microbiol Immunol Hung. 2009; 56: 301-312.

  17. Cusi MG, Martorelli B, Di Genova G, Terrosi C, Campoccia G, Correale P. Age related changes in T cell mediated immune response and effector memory to Respiratory Syncytial Virus (RSV) in healthy subjects. Immun Ageing. 2010; 7: 14.

  18. Grubeck-Loebenstein B. Fading immune protection in old age: vaccination in the elderly. J Comp Pathol. 2010; 142 Suppl 1: S116-S119.

  19. Zhou XJ, Saxena R, Liu Z, Vaziri ND, Silva FG. Renal senescence in 2008: progress and challenges. Int Urol Nephrol. 2008; 40: 823-839.

  20. Cotreau MM, von Moltke LL, Greenblatt DJ. The influence of age and sex on the 
clearance of cytochrome P450 3A substrates. Clin Pharmacokinet. 2005; 44: 33-60.

  21. Radley S, Keighley MR, Radley SC, Mann CH. Bowel dysfunction following hysterectomy. Br J Obstet Gynaecol. 1999; 106: 1120-1125.

  22. Bhutto A, Morley JE. The clinical significance of gastrointestinal changes with 
aging. Curr Opin Clin Nutr Metab Care. 2008; 11: 651-660.

  23. Wickremaratchi MM, Llewelyn JG. Effects of ageing on touch. Postgrad Med J. 2006; 82: 301-304.

  24. Hilton D, Iman N, Burke GJ, Moore A, O’Mara G, Signorini D, et al. Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study. Am J Gastroenterol. 2001; 96: 380-384.

  25. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003; 21: 61-72, vi.

  26. Stroman DL, Bayouth CV, Kuhn JA, Westmoreland M, Jones RC, Fisher TL, et al. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg. 1999; 178: 485-489.

  27. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998; 338: 141-146.

  28. Wolff WL, Hindman R. Acute appendicitis in the aged. Br J Sur. 1976; 63: 956-960.

  29. Goldenberg IS. Acute appendicitis in the aged. Geriatrics. 1955; 10: 324-327.

  30. Hubbell DS, Barton WK, Solomon OD. Appendicitis in older people. Surg Gynecol Obstet. 1960; 110: 289-292.

  31. Coran AG, Wheeler HB. Early perforation in appendicitis after age 60. JAMA. 1966; 197: 745-748.

  32. Albano WA, Zielinski CM, Organ CH. Is appendicitis in the aged really different? Geriatrics. 1975; 30: 81-88.

  33. Freund HR, Rubinstein E. Appendicitis in the aged. Is it really different? Am Surg. 1984; 50: 573-576.

  34. Owens BJ, Hamit HF. Appendicitis in the elderly. Ann Surg. 1978; 187: 392-396.

  35. Blake R, Lynn J. Emergency abdominal surgery in the aged. Br J Surg. 1976; 63: 956-960.

  36. Pieper R, Kager L, Näsman P. Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand. 1982; 148: 51-62.

  37. Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990; 160: 291-293.

  38. Lukmann R. Incidence and case fatality rates for acute appendicitis in California. A population-base study of effects of age. Am J Epidermiol. 1989; 129: 905-918.

  39. Paajanen H, Kettunen J, Kostianen S. Emergency appendicitis in patients over 80 years old. Am Surg. 1994; 60: 950-953.

  40. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995; 61: 40-44.

  41. Rub R, Margel D, Soffer D, Kluger Y. Appendicitis in the elderly: what has changed? Isr Med Assoc J. 2000; 2: 220-223.




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