Appendicitis. The diagnostic challenge continues.

The typical clinical manifestations of appendicitis are well described, but atypical presentations occur frequently. Uncertainty regarding the diagnosis may cause long delays before appropriate treatment is rendered. Several patients in whom the diagnosis was obscure are presented. Barium enema, ultrasonography, computerized tomography, and laparoscopy each may be helpful in diagnosis, but these studies should be used selectively and negative results can be misleading. It is wise to consider other causes of abdominal pain in patients suspected of having appendicitis, so that unnecessary operation can be avoided. It is more important to suspect appendicitis in patients who appear to have nonsurgical conditions of the abdomen, so that the incidence of perforation can be minimized.