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

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.