With the increase in the aging population in our society, the incidence of acute appendicitis in the elderly has increased accordingly. Because the elderly are dull to pain, their abdominal muscles are atrophied and their self-defense is greatly reduced, the clinical manifestations of acute appendicitis in the elderly are often atypical and often lack the features of acute appendicitis in young people. Acute appendicitis often has typical abdominal pain characteristics, that is, the abdominal pain attack starts in the upper abdomen, gradually moves around the navel, generally 6-8 hours later and then shifts and confined to the right lower abdomen, about 70% – 80% of patients have this typical metastatic abdominal pain characteristics, the degree of abdominal pain is related to the degree of lesion, abdominal pain is heavy, the appendix lesion is also heavy. In addition to abdominal pain, it is often accompanied by gastrointestinal symptoms such as anorexia, nausea, vomiting, abdominal distention and diarrhea. There is generalized weakness, rapid heartbeat, and fever up to 38°C or even 39°C or 40°C. There is also pressure pain in the right lower abdomen, and the degree of pressure pain correlates with the extent of the lesion. When blood is drawn for routine blood tests, the white blood cell count is often significantly elevated. However, clinical data show that 60%-80% of elderly people with appendicitis do not have the above-mentioned typical clinical manifestations, i.e. abdominal pain without metastatic features, often limited to the upper abdomen or around the umbilicus, and a few patients do not even have conscious abdominal pain, no obvious symptoms in the gastrointestinal tract, less nausea and vomiting, and the routine blood count is not elevated, and the body temperature can be normal as usual, so they are neglected and cannot get timely The clinical manifestations of appendicitis in the elderly The clinical manifestations of appendicitis in the elderly are light but the pathological changes are heavy, with three major features: many complications, easy perforation and high mortality. The aging of the organs of the elderly and the frequent complications of cardiovascular disease, diabetes, emphysema, and liver and kidney insufficiency make the disease complex and serious. Arteriosclerosis in the elderly, the appendix artery will also change accordingly, which will easily cause ischemic necrosis of the rotten tail, plus the appendix mucosa is thinner in the elderly, so the appendix is easily perforated. Once the appendix is perforated, it is easy for the old and frail elderly to die from complications such as diffuse peritonitis and infectious shock. For this reason, once abdominal pain occurs in the elderly, family members or myself should think about the possibility of this disease and seek medical attention as soon as possible to avoid delaying the condition, delaying the diagnosis, and having a life-threatening appendiceal perforation.