Introducere: Stabilirea apendicitei acute (AA) este dificila si ramane una dintre cele mai provocatoare probleme diagnostice in
chirurgie la toate grupele de varsta. Pacientii in varsta inaintata au reactivitatea scazuta, simptomele si modificarile patologice
deseori sunt incompatibile cu durerea abdominala, in timp ce diagnosticul diferential este dificil datorita altor boli numeroase
posibile, care pot imita AA.
Scopul studiului a constat in evaluarea valorii informative a semnelor clinice conventionale, precum si rolului metodelor imagistice
in diagnosticul si decizia in favoarea interventiei chirurgicale la pacientii varstnici cu AA.
Material si metode: In analiza retrospectiva au fost inclusi 78 pacienti tratati in Clinica chirurgie generala cu AA confirmata histologic
(Ianuarie-Octombrie 2017). Femeile – 52 (66,6%), barbatii – 26 (33,3%). Dintre pacientii din grupul de studiu 68 (87,2%) au fost
in varsta de sub 60 de ani, iar 10 (12,8%) – peste 60 de ani. A fost colectata informatia privind datele demografice ale pacientilor,
prezentarea clinica initiala, teste de laborator, investgatiile imagistice cu accent pe ultrasonografia abdominala (US) si tomografia
computerizata (CT).
Rezultate: Durata spitalizarii peste 24 de ore preoperator a fost considerabil mai mare la varstnici: 30% comparativ cu 8,8% in grupul
pacientilor tineri, insa aceasta constatare nu a fost statistic semnificativa (p> 0,05). Doar in doua (20%) cazuri, diagnosticul de AA
la pacientii varstnici s-a bazat doar pe date clinice comparativ cu 44 (64,7%) – la populatia mai tanara. La restul 8 bolnavi varstnici
au fost necesare metode suplimentare de diagnostic (scanare US sau CT abdominala) pentru precizarea apendicitei, excluderea
diagnosticelor alternative ale abdomenului acut si argumentarea deciziei in favoarea tratamentului chirurgical (80% versus 35,3% la
pacientii mai tineri, p <0,05).
Concluzii: Simptomele clasice ale AA nu sunt indicative la pacientii varstnici si nu pot servi drept baza pentru un diagnostic cert, ceea
ce conditioneaza utilizarea mai frecventa a modalitatilor imagistice, inclusiv US si CT, iar decizia despre interventie chirurgicala este
deseori bazata pe datele instrumentale.

Introduction: The diagnosis of acute appendicitis (AA) is difficult and remains one of the most challenging diagnostic issues in
surgery in all age groups. Aging patients have poor response, their symptoms and pathological changes are often inconsistent with
abdominal pain, whereas the differential diagnoses are wide and difficult due to many other possible diseases, which may mimic
AA.
Aim of study was to evaluate the informative value of conventional clinical signs on presentation, as well as the role of imaging
methods in diagnosis and decision for surgery in the elderly patients with AA.
Material and methods: A total of 78 patients treated in Department of General Surgery with histological confirmed AA were
included in the retrospective analysis (Jan-Oct 2017). Women were 52 (66.6%) and men – 26 (33.3%). Among study group patients
68 (87.2%) were under the age of 60 years, and 10 (12.8%) were over 60 years. The information regarding patient’s demographic
data, initial clinical presentation, laboratory tests, radiological studies with focus on abdominal ultrasonography (US) and computed
tomography (CT) scan was collected.
Results: The duration of the preoperative hospitalization over 24 hours was considerable more in the elder group: 30% vs. 8.8% in
the younger group, but this finding were not statistically significant (p>0.05). Only in two (20%) cases the diagnosis of AA in the
elderly patients was based only on clinical data against 44 (64.7%) – in younger population. In the remaining 8 elderly patients,
additional instrumental methods of diagnosis (abdominal US or CT scan) were required to precise the appendicitis, to exclude
alternative diagnoses of acute abdomen, and to make up the decision for surgical treatment (80% vs. 35.3% in the younger patients,
p<0.05).
Conclusions: The classic symptoms of AA are not indicative in elderly patients and cannot serve as a basis for reliable diagnosis,
which requires more frequent use of imaging modalities, including US and CT, and the decision for surgery is often taken on the
basis of instrumental data.