Acute appendicitis is a very common disease, and with the increase in the aging population of society, the incidence of acute appendicitis in the elderly has increased accordingly. Symptoms and signs are often atypical in the elderly because of their dull sensation of pain and weak abdominal muscles. The clinical manifestations are mild but the pathological changes are severe. There is often no obvious fever, and white blood cell elevation is not obvious, so it is easy to misdiagnose. In addition, because the elderly often have arteriosclerosis, the appendix is prone to ischemic necrosis, and the elderly are often combined with cardiovascular disease, diabetes mellitus and renal insufficiency, making the condition complex and serious. Therefore, once the diagnosis is confirmed, surgery should be performed promptly, and attention should be paid to the management of all kinds of accompanying medical diseases. In the elderly, sometimes right lower abdominal pain should also be noted to exclude colon diseases, such as colon cancer. Intraoperative attention should be paid to the comprehensive exploration of abdominal organs.