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Do You Know Where Your Appendix Is? Appendicitis in the Older Adult Traveler

From the Patient Advocate

By Deborah Bickel

Do you know where your appendix is? This is not just a trivial question for those of us over 50 and traveling to remote areas, sailing the seas, or climbing mountains. Back in the day, a healthy appendix was often removed during other abdominal surgery in the interest of preventing a second surgical emergency. Women, most commonly, had an uninfected appendix removed during obstetric or gynecological surgeries. Current thinking is that the appendix may serve an immune function, preventing the growth of potentially harmful bacteria in the gut.

Appendicitis is not just a childhood surgical emergency. An infected appendix is one of the most common reasons for abdominal surgery in the older population, and the older we get, the less likely a successful outcome from surgical intervention. As older adults, we are eight times more likely to succumb as a result of appendicitis than a young and otherwise healthy patient with appendicitis.

The reasons for this are many and, of course, can often include underlying ill health. The most common reason is that the diagnosis is often delayed. We delay getting to the doctor because the symptoms just don’t present like they do in children or the younger adult. Fewer than half of us over 50 will have “classic” symptoms, such as severe right-sided abdominal pain (especially with movement), fever, and aversion to food.

What does this mean in practical terms to the older adult? First, find out if you have had your appendix removed. Some of the most common symptoms in an older adult are maddeningly similar to the usual ”tourista” symptoms. Diarrhea, mild to moderate diffuse abdominal pain, low grade fever, and fatigue are all common symptoms of appendicitis in the older adult.

Increasingly, especially outside of the United States, a trial of antibiotics is offered for appendicitis before surgical removal is considered. If a physician can be sure the appendix has not ruptured and close follow up can be assured, many cases of ”appendicitis” can be resolved without surgery.

If you do still have your appendix, the best way to prevent a surgical emergency or rupture is to be alert to the possibility that what you think is a stubborn case of traveler’s diarrhea may be something more serious. If you have had abdominal pain and a fever for more than three days, seek a qualified medical consult, being sure to tell your doctor that you have not had your appendix removed.

Deborah lives full time in SMA and has practiced medicine as a physician assistant in the US as well as many countries of Latin America and Africa. She trained at Stanford University Medical School and has a master’s in Public Health from UC Berkeley California.


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