We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.

Purpose
This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients.
Methods
The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed.
Results
Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013).
Conclusion
Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

Citations

• The road less recovered: Examining the effect of trauma on frailty trajectories in older patients
  Jessica Falon, Priyadharshani Samarasinghe, James Elhindi, Urna Rahman, Aswin Shanmugalingam, Isabella Zappala, Jeremy Hsu
  Journal of Trauma and Acute Care Surgery.2025;[Epub]     CrossRef

Purpose
The safety and efficacy of laparoscopic cholecystectomy (LC) in elderly patients is a matter of concern because morbidity and clinical risk are higher in elderly patients; and some clinicians recommend non-surgical supportive treatments. There is limited data reported in the literature for LC in super-elderly individuals (aged ≥ 80 years). This study compared the clinical outcome for the elderly and super-elderly patients undergoing LC.
Methods
Patients who had a cholecystectomy for acute or chronic cholecystitis, and empyema of the gall bladder between January 2011 and June 2018 were analyzed retrospectively. The clinical outcomes of the super-elderly patients (≥ 80 years, Group 2) were compared with elderly patients (65-79 years, Group 1). Complications, conversion rate, postoperative hospital stays were assessed.
Results
The conversion rate was 5.5% and 8.4% in Groups 1 and 2, respectively (p = 0.749). The surgical or medical complication rates were similar in both groups. A significant difference in operation time was observed between groups (p < 0.001). Although the super-elderly patients had longer postoperative hospital stays (7.10 ± 6.98) than the elderly patients (4.60 ± 6.06), there was no significant difference with between the 2 groups (p = 1.000).
Conclusion
The clinical outcomes of the conversion rate, complications, and mortality were similar in patients aged 65 to 79 years and ≥ 80 years. Therefore, LC is deemed to be a safe and simple procedure for the super-elderly.

Citations

• The Safety of Laparoscopic Cholecystectomy in Super-elderly Patients: A Propensity Score Matching Analysis
  Shigetoshi Naito, Masatoshi Kajiwara, Ryo Nakashima, Takahide Sasaki, Suguru Hasegawa
  Cureus.2023;[Epub]     CrossRef
• Safe and feasible outcomes of cholecystectomy in extremely elderly patients (octogenarians vs. nonagenarians)
  Su Min Kim, Min Ho Shin, Nam Kyu Choi
  Journal of Minimally Invasive Surgery.2021; 24(3): 139.     CrossRef