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Surgical Abdomen

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Geriatric Gastroenterology

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Abstract

Abdominal pain is a common and challenging problem in the geriatric population, characterized by severe pain that requires an urgent and specific diagnosis. A rapidly worsening prognosis is possible in absence of prompt intervention. The most common causes of acute abdomen in the older age group are acute cholecystitis, acute appendicitis, perforated peptic ulcer disease, acute pancreatitis, intestinal obstruction, ischemic bowel disease, diverticulitis, obstructed hernias and aortic aneurysm rupture. Symptoms and physical findings often differ from that of the younger patient and are unreliable in older people, contributing to an estimated 40% misdiagnosis rate. Misleadingly benign examination, inordinate delays of initial assessment, diagnosis and treatment, along with coexisting disease, contribute to significantly increased mortality. Upright chest X-ray initially to exclude free intraperitoneal air, followed by CT, have the highest yield. Older adults have acceptable survival rates after major abdominal surgery, but tolerate complications poorly. While aggressive resuscitation, high level of suspicion for severe pathology and prompt surgical intervention tailored to the physiologic status are crucial, early diagnosis is the most modifiable risk factor for improving outcome.

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Authors and Affiliations

  1. Iowa Methodist Medical Center, Des Moines, IA, USA

    Carlos A. Pelaez

  2. Carver College of Medicine, University of Iowa, Iowa City, IA, USA

    Carlos A. Pelaez

  3. New York Medical College, Valhalla, NY, USA

    Nanakram Agarwal

  4. Montefiore Medical Center, Bronx, NY, USA

    Nanakram Agarwal

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  1. Carlos A. Pelaez
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  2. Nanakram Agarwal
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Correspondence to Nanakram Agarwal .

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  1. Saint Peter's Healthcare System, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Albert Einstein College of Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

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Pelaez, C.A., Agarwal, N. (2020). Surgical Abdomen. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_84-1

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