Incidence and predictors of appendiceal tumors in elderly males presenting with signs and symptoms of acute appendicitis

Patients with appendiceal tumors (AT) frequently present with the same signs and symptoms as acute appendicitis (AA). The purpose of this study was to identify the incidence of AT in a population of patients greater than 60 years of age thought to have AA, and to identify presenting factors that can help differentiate the 2 disease processes. An institutional review board-approved, retrospective review was performed identifying all patients greater than 60 years old who underwent either appendectomy or colectomy after presenting with signs and symptoms of AA from Janaury 1997 to April 2004. Patient records were examined for demographic variables, presenting signs and symptoms, and pathology. A total of 34 patients fit the entry criteria; 8 (24%) had AT. Average duration of symptoms was significantly longer (4.9 ± 1.9 versus 2.3 ± 0.3 days; P = 0.01) and hematocrit lower (36.5 ± 2.3 versus 42.4 ± 1.0%; P = 0.01) for patients with AT compared with patients with AP. No other significant differences in presenting signs and symptoms were noted. There is an increased incidence of appendiceal neoplasms among elderly patients presenting with signs and symptoms of AA. Distinction between AT and appendicitis is difficult preoperatively, but AT should be suspected when patients present with longer duration of symptoms or reduced hematocrit.