Clinical significance of appendicoliths in elderly patients over eighty years old undergoing emergency appendectomy: A single-center retrospective study.

Background: Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.

Aim: To analyze the clinical data of elderly patients undergoing emergency appendectomy for acute appendicitis, aiming to improve treatment strategies.

Methods: The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed. The patients were divided into two groups based on the presence of an appendicolith or not, and clinicopathological and surgery-related features were compared between the two groups.

Results: The duration of abdominal pain in all 122 patients ranged from 5 to 168 h. All patients underwent emergency appendectomy: 6 had an open appendectomy, 101 had a laparoscopic appendectomy, and 15 required conversion from laparoscopic to open surgery, resulting in a conversion rate of 12.9% (15/116). The patients were divided into two groups: Appendicolith group (n = 46) and non-appendicolith group (n = 76). Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene (84.8% vs 64.5%, P = 0.010) and perforation (67.4% vs 48.7%, P = 0.044), and had a lower surgical conversion rate (2.2% vs 19.7%, P = 0.013). The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them. All patients were successfully discharged.

Conclusion: Around 40% of patients over 80 years old with acute appendicitis have an appendicolith, increasing their risk of developing appendiceal gangrene and perforation, and therefore should receive timely surgical treatment.