Acute appendicitis in the elderly is a difficult condition to diagnose and treat due to its atypical clinical presentation, the co-morbidities that these patients have and the risk of developing complications like perforation. The diagnosis involves the use of imaging modalities like computerized tomography and the treatment is by performing an appendectomy. Laparoscopic appendectomy is slowly becoming the gold standard in the surgical treatment of acute appendicitis in the elderly. We have conducted this review article to look at the diagnosis and management of acute appendicitis in the elderly. The role of laparoscopic appendectomy in the surgical treatment of acute appendicitis in the elderly is also investigated.