Emergency bowel surgery in the elderly.
OBJECTIVE
Emergency bowel operations are commonly performed in emergency units and carry high morbidity and mortality risk, particularly in elderly patients. The aim of the present study was to review the presentation, management and outcome of bowel emergencies in elderly patients.


METHODS
The records of 248 patients (91 females, 157 males) aged over 65 years, undergoing emergency bowel operation during a five-year period, were reviewed. Patient's age, sex, details of presentation, past medial history, presence of coexisting diseases, and type of surgical procedures were noted, and their effects/any unfavorable outcomes were all analyzed. Data were evaluated by using SPSS 9.0 for Windows statistical program. A p value less than 0.05 was accepted as significant.


RESULTS
Mean age was 72.5 years. There were 85 (34%) isolated small bowel emergencies (SBE) and 153 (62%) isolated large bowel emergencies (LBE). The most common disease in SBE was mesenteric ischemia in 67 (27%), followed by adhesions, 26 (10%). Malignant bowel disease in 59 (24%) and sigmoid volvulus in 43 (17%) accounted for the majority of LBE. Sixty-five percent (161) of patients presented with obstruction and 46 (19%) patients had bowel perforation. Malignant disease, volvulus and mesenteric ischemia carried high resection rates (82%, 78% and 76%, respectively). Overall morbidity and mortality rates were 42% (105) and 28% (70), respectively.


CONCLUSIONS
Emergency bowel operations have poor outcome in the elderly. Nature and extent of disease, presence of coexisting cardiopulmonary disease, late admission and presence of peritonitis significantly affect management and outcome of elderly patients with bowel emergencies.
Külah
Bahadir
B
3rd Surgical Department, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Gülgez
Bariş
B
Ozmen
M Mahir
MM
Ozer
M Vasfi
MV
Coşkun
Faruk
F
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality; D004638:Emergency Treatment / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D007414:Intestinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007415:Intestinal Obstruction / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome