Abdominal Pain in the Elderly

The most important point to be made is that a serious cause in patients with abdominal pain is much more likely in the elderly.

Some of the data available indicates a 60% admission rate, a 20% rate of surgery and a 5% death rate.

  • Specific diseases more common in the elderly include
    • cholecystitis
    • diverticulitis
    • bowel obstruction
    • AAA
    • intestinal ischemia

The way in which these and other conditions are diagnosed and treated is not substantially different in the elderly. What may differ is that elderly patients:

  • The elderly often present late
  • The elderly often have less severe, less "classic" signs and symptoms

Tips to avoid missing a serious diagnosis in this age group are as follows.

  • Be liberal in the use of imaging
  • Admit and/or consult on patients you are worried about.
    • This can be difficult as a modern day phenomenon is that admitting physicians often require a definite diagnosis prior to admission.
    • Consultants (in this case usually surgeons) often are reluctant to get involved unless imaging reveals a "surgical" diagnosis.
  • Be cautious in making a benign dx such as gastroenteritis, gastritis, esophagitis, non-specific abdominal pain, constipation, etc.