UMEM Educational Pearls

Category: Geriatrics

Title: appendicitis misdiagnosis in the elderly

Keywords: geriatrics, elderly, appendicitis (PubMed Search)

Posted: 6/7/2010 by Amal Mattu, MD (Updated: 7/18/2024)
Click here to contact Amal Mattu, MD

Up to 25% of elderly patients with appendicitis are initially sent home from the ED, an indication of the high misdiagnosis rate for appendicitis in the elderly population. Why are elderly patients so often misdiagnosed when they have appendicitis? The answer is simple....they present very atypically.


  • The classic migratory pattern (periumbilical pain that migrates to the RLQ) is absent in > 50%
  • Nasea, vomiting, and anorexia are each absent in > 50%
  • Fever is absent in up to 50%
  • Guarding and rebound are absent in 50%
  • The WBC is normal in up to 45%
  • Up to 15% have pyuria or bacteriuria, leading to misdiagnoses of UTI

Expect the atypical in elderly patients!