Although appendicitis is more common in younger age groups, it is still an important cause of abdominal pain in the elderly. Perhaps due to a diminished inflammatory response, the elderly can present with less impressive symptoms and physical signs, longer duration of symptoms, and decreased leukocytosis compared to younger patients. Perforation is thus more common, occurring in as many as 50% of patients over age 65. These patients may have cardiac, pulmonary, and renal conditions resulting in considerable morbidity and mortality from perforation. In one series, the mortality from perforated appendicitis in patients over age 80 was 21%.These factors argue that right lower quadrant pain in elderly patients must be aggressively investigated. Due to the multiple other possible causes of abdominal pain in this patient population (including malignancy, diverticulitis, and perforated peptic ulcer disease), prompt CT scan is advocated when the diagnosis is in question.