• appendicitis;
  • diagnosis;
  • elderly;
  • rupture

Background:  The aim of this study was to identify factors associated with rupture in elderly patients with acute appendicitis.

Methods:  The medical records of 601 consecutive patients >60 years of age with acute appendicitis between 1995 and 2005 were retrospectively reviewed. Historical, clinical and laboratory factors in patients with both intact and ruptured appendices were examined with univariate and multivariate analyses by logistic regressions.

Results:  Nine factors predicted appendiceal rupture age (odds ratio (OR) 1.05, confidence interval (CI) 1.02–1.07), male sex (OR 1.96, CI 1.35–2.06), preadmission duration of pain (OR 1.23, CI 1.11–1.36), interval of time from admission to surgery (OR 1.02, CI 1.01–1.04), fever >38°C (OR 2.59, CI 1.78–3.77), left shift in leucocyte count >76% (OR 2.34, CI 1.27–4.32), anorexia (OR 2.03, CI 1.38–2.99) and a retrocaecally positioned appendix (OR 1.93, CI 1.15–3.24).

Conclusion:  The incidence of appendiceal rupture, or complications secondary to appendiceal rupture, in elderly patients may be decreased if surgery is expedited when the temperature is >38°C or there is a left shift in leucocyte count >76%, especially in men with anorexia.