Mexico Life
Tourista, or appendicitis? Tourista, or appendicitis?

Appendicitis can be mistaken for ‘tourista’

Infected appendix can be problematic for older people

Do you know where your appendix is? This is not just a trivial question for those of us over 50 and traveling to remote areas, sailing the seas or climbing mountains.

Back in the day, a healthy appendix was often removed during other abdominal surgery in the interest of preventing a second surgical emergency.

It used to be standard procedure to remove the appendix in routine abdominal surgery for other conditions. Women, most commonly, had an uninfected appendix removed during obstetric or gynecological surgeries.

Current thinking is that the appendix may serve an immune function, preventing the growth of potentially harmful bacteria in the gut.

Appendicitis is not just a childhood surgical emergency. An infected appendix is one of the most common reasons for abdominal surgery in the older population, and the older we get, the less likely a successful outcome from surgical intervention.

Older adults are eight times more likely to succumb as a result of appendicitis than a young and otherwise healthy patient.

The reasons for this are many, and of course can oftentimes include underlying ill health. The most common reason is that the diagnosis is often delayed. We delay getting to the doctor because the symptoms just don’t present like they do in children or the younger adult.

Fewer than half of us over 50 will have “classic” symptoms, such as severe right-sided abdominal pain (especially with movement), fever and aversion to food.

What does this mean in practical terms to the older adult? First, find out if you have had your appendix removed. Some of the most common symptoms in an older adult are maddeningly similar to the usual “tourista” symptoms.

Diarrhea, mild to moderate diffuse abdominal pain, low grade fever and fatigue are all common symptoms of appendicitis in the older adult.

Increasingly, especially outside of the United States, a trial of antibiotics is offered for appendicitis before surgical removal is considered. If a physician can be sure the appendix has not ruptured and close follow-up can be assured, many cases of “appendicitis” can be resolved without surgery.

If you still have your appendix, the best way to prevent a surgical emergency or rupture is to be alert to the possibility that what you think is a stubborn case of traveler’s diarrhea may be something more serious.

If you have had abdominal pain and a fever for more than three days seek a qualified medical consultation, being sure to tell your doctor that you have not had your appendix removed.

Do you have a question related to obtaining health care in Mexico? Send it to and Deborah will do her best to answer it for you.

Deborah Bickel lives in San Miguel de Allende and is the founder and principal of Be Well San Miguel patient advocacy services. She is an international health worker with a master’s degree in public health from the University of California at Berkeley and is a graduate of the Stanford University Primary Care Associate program. She has practiced medicine in the San Francisco Bay Area, Latin America and Africa.


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