A literature review and case report: Traumatic appendicitis in an elderly patient with spinal cord injury and medical comorbidities

Abstract

Acute appendicitis is a leading cause of acute abdomen, yet its onset after blunt trauma remains exceedingly rare and diagnostically challenging – particularly in the elderly and in patients with concurrent neurological injuries. We present the case of a 65 year old woman who developed acute appendicitis following a motor vehicle collision that also caused thoracic spinal fractures with canal involvement. Initially hemodynamically stable with a normal abdominal examination and a negative focused assessment with sonography for trauma, she developed right lower quadrant pain 22 h posttrauma, which localized and intensified by 56 h. Contrast enhanced computed tomography (CT) at 59 h revealed an 8 mm inflamed appendix with periappendiceal fat stranding, and open appendectomy at 61 h confirmed acute appendicitis with fibrous obliteration. The patient’s recovery was uneventful. This case underscores how concurrent spinal injury and immobilization can obscure evolving abdominal pathology, emphasizing the importance of repeated clinical assessment and timely CT imaging in elderly polytrauma patients. In addition to the case presentation, we conducted a comprehensive literature review of all reported cases of posttraumatic appendicitis, summarizing demographic, clinical, and diagnostic patterns to contextualize this rare phenomenon. Together, these findings reinforce the need for heightened diagnostic vigilance and multidisciplinary coordination when evaluating delayed abdominal pain in trauma patients with neurological compromise.

How to cite this article: Khosropanah S, Rahmanian M, Ashrafazimi M, Abad AR. A literature review and case report: Traumatic appendicitis in an elderly patient with spinal cord injury and medical comorbidities. Turk J Emerg Med 2026;26:256-61.

Ethical approval for this case report was obtained in accordance with our institutional guidelines. Written informed consent was secured directly from the patient for the publication of this clinical case and any accompanying radiological images. All patient data have been thoroughly anonymized to ensure complete confidentiality and adherence to standard ethical protocols.

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

• Sarah Khosropanah: Writing – original draft, data collection (patient information)
• Mohsen Rahmanian: Writing – original draft, data collection (patient information)
• Amir Rahmanian Sharif Abad: Project administration, supervision, data acquisition (facilitated data gathering, saw the patient), writing – review and editing, preparation for publication
• Mohammad Ashrafazimi: Data acquisition (facilitated data gathering, saw the patient), Surgery (treated the patient as a surgeon), Supervision, Writing – review and editing

None declared.

None.