Subtleties in the Emergency Care of Elderly Patients with Biliary Disease

Harold H. Bach, Anthony J. Baldea, Joseph M Galante

Research output: Contribution to journalReview article

Abstract

The management of acute biliary disease in the elderly population can be a challenging endeavor. Older patients often present with atypical symptoms or advanced disease, which can further complicate the treatment options. A treating physician must have a high index of suspicion for biliary disease as a cause of acute intra-abdominal emergencies in the elderly patient that presents with vague abdominal complaints. While the initial workup of these patients is similar to their younger counterparts, the utilization of advanced imaging modalities can often assist in clarifying the diagnosis. The successful treatment of an elderly patient with an acute biliary emergency must take many factors into account. Any decision to proceed with emergency surgery on an elderly patient should be predicated on thorough pre-operative cardiopulmonary risk stratification as well as the utilization of frailty scores. Candid discussions should be held with the patient and his/her family in order to highlight the benefits and risks of any invasive intervention and the associated increased mortality rate since not all patients will be a reasonable operative candidate. For patients deemed to have an appropriate mortality risk for surgical intervention, both laparoscopic and open approaches to cholecystectomy may be safely deployed in the elderly population. Elderly patients with acute biliary disease are often not suitable candidates for emergency surgery, due to the duration of their symptoms, delayed presentation, multiple underlying comorbidities, or acute physiological derangements. Thus, it is imperative that treating physicians understand the many non-operative management strategies that exist to take care of acute biliary disease in this specific patient population.

Original languageEnglish (US)
Pages (from-to)44-48
Number of pages5
JournalCurrent Geriatrics Reports
Volume5
Issue number1
DOIs
StatePublished - Mar 1 2016

Keywords

  • Biliary disease
  • Cholecystectomy
  • Cholecystostomy tube
  • Elderly
  • Emergency surgery
  • ERCP
  • Frailty
  • Non-operative management

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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