Towards an evidence-based management of right iliac fossa pain in the over 50-year-old patient

Introduction Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the ‘older’ population, as they have a higher prevalence of acute colonic diverticulitis and colonic neoplasia, both of which should be identified prior to surgery. There is, however, no published evidence to support this practice. Methods We retrospectively reviewed the records of all patients aged over 50 years who presented with right iliac fossa (RIF) pain to a district general hospital. We determined whether tenderness was predominantly right- or left-sided and whether systemic inflammatory response syndrome (SIRS) was present on admission. The use of imaging modalities, their results and, if performed, operative findings were recorded. Results Of 3160 patients identified, 89 met the inclusion criteria. Diagnoses included appendicitis (27%), neoplasia (15%), non-specific abdominal pain (15%) and acute coloni...