Atypical forms of appendicitis
When the appendix is retrocecal or retroileal in location, the inflamed appendix is often shielded from the anterior abdomen. The pain is often less pronounced, and localizing signs on physical examination are uncommon.
Symptoms and signs of appendicitis in older patients are subtle. Pain is often minimal, fever is only mild, and leukocytosis is unreliable. A high index of suspicion is essential.