Appendicitis is a Severe Disease in Elderly Patients: A Twenty-Year Audit.

BACKGROUND AND OBJECTIVES: Life expectancy has increased substantially. Elderly patients currently represent a large part of patients requiring emergency abdominal surgery. The aim of this study was to evaluate the postoperative outcomes of elderly patients who underwent appendectomy in a single French tertiary center. METHODS: We retrospectively reviewed the medical records of all patients who underwent appendectomy for acute appendicitis between January 1, 1994 and December 31, 2014. We used the French threshold of ≥ 75 y-old to define elderly patients. Hence, elderly patients who underwent appendectomy were compared to the younger group. RESULTS: During the study period, 2,060 consecutive patients underwent appendectomy for acute appendicitis. Laparoscopic appendectomy was performed in 52% of cases. Similar rates of laparoscopic approach were recorded in both groups, but conversion to open surgery was six times more frequent in elderly patients (17% vs. 3%; P < .0001). A higher incidence of complicated appendicitis was observed in the elderly group (63% vs. 13.6%; P < .0001). Complications occurred more frequently in the elderly group (46% vs. 8%; P < .0001). 30-d mortality was 0.15% for patients < 75 y and 6.15% for elderly patients (P < .0001). Unsuspected presence of an appendiceal neoplasm was higher (7.7%) in the elderly population. CONCLUSION: This study highlights the fact that appendicitis in the elderly is associated with a higher rate of complicated appendicitis, morbidity, and mortality.

"Chronic Disseminated Aspergillosis," a Novel Fungal Immune Reconstitution Inflammatory Syndrome.

We report a case of chronic hepatosplenic aspergillosis following immune reconstitution complicating colic aspergillosis in an AIDS patient with multicentric Castleman disease. Symptoms mimicked the clinical presentation of chronic disseminated candidiasis and responded to corticosteroid. This emerging entity enlarges the spectrum of fungal immune reconstitution inflammatory syndrome in the HIV setting.

Laparoscopic Adrenalectomy in Elderly Patients.

With increase life expectancy, surgical indications in elderly become more frequent. The aim of this study was to analyze indications and outcome of laparoscopic adrenalectomy in patients over 75. Between 1994 and 2014, 641 patients underwent laparoscopic adrenalectomy. Preoperatively, all patients had a standardized preoperative work-up. Patients over 75 were compared with a control group of younger patients. The median age was 52 years (41 to 61) and 3.6% of patients (n=23) were over 75. Patients over 75 were more frequently operated for malignant lesion (21.7% vs. 4.7%; P=0.005). There was no postoperative mortality. Conversion rate was 3.4% (n=22), with no significant difference between the groups. The overall morbidity and severe morbidity rates were, respectively, 16.9% and 3.3%, with no significant difference between the groups. In experienced team and for selected patients, laparoscopic adrenalectomy after 75 years is safe, without increased postoperative morbidity, as compared with younger population.

Chest wall resection for multifocal osseous haemangioma.

Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms.