&NA;Sine the turn of the century, the elderly population, particularly those over the age of 80, has been increasing steadily. Consequently, the surgeon will be confronted frequently with the diagnostic challenge of acute appendicitis in this population. Over the past ten years, 13 patients over the age of 80 were treated for acute appendicitis at the St. Lukes‐Roosevelt Hospital Center. The mean duration of symptoms was 2.4 days; all patients complained of abdominal pain, with 72 percent of patients having right lower quadrant involvement. Ninetytwo percent had perforated prior to surgery, and 23 percent did not survive the disease. This high mortality rate is atributed to both a delay in presentation to the physician and a further delay in proper treatment due to misdiagnosis. This is a disease with which every physician must be familiar and be continually vigilant, as correct diagnosis and prompt treatment are the keys to averting high morbidity and mortality rates.