Senior House Officer of Trauma and Emergency Surgery

Acute appendicitisis the clinical condition which refer to inflammation of the vermiform appendix1. It is the most common abdominal emergency2,3,4 .it accounts for more than 40,000 hospital admissions in England every year 5 . Approximately 8% of the population in Western countries would have appendicitis during their life 6 .In the United States, the estimated incidenc of acute appendicitis is 11 cases per 10,000 population 5 . However, in South Africa, the incidencewas estimated to be less than 9 per 100,000 6 .Appendectomy is considered the most common emergency surgical procedure worldwide6,8 ,9. The cause of acute appendicitis is unknown but it is multifactorial; luminal obstruction , dietary and familial factors have been suggested 5 . Fecoliths are the most common cause of obstruction. It was demonstrated that the mean duration of abdominal pain in patients with gangrenous appendix is 46.2 hours and 70.9 hs for perforated 7 .

The peak incidence of acute appendicitis is at the age of 10 to 30 years 6,10. There are special features for appendicitis according to age 1. A.A is primarily a disease of the younger population, with only 5-10% of cases occurring in elderly people, but the incidence of acute appendicitis in elderly began to increase with the increase in life expectancy14. Older patients with acute abdominal pain are high-risk patients, unlike their younger counterparts15 . Morbidity and mortality rates are greater in elderly due to atypical presentations and delay in diagnosis leading to increase rate of perforation and intra-abdominal infection.. They need to be clinically evaluated by experienced surgeons within a narrow time margin14,15.