Doctors know nowadays that diagnosing appendicitis is most easy and most difficult at the same time. Symptoms like pain around the navel, nausea, vomiting can also be caused by other disorders in the abdominal area. The pain in appendicitis localizes in the right ileal fossa where a sensation of tenderness and discomfort occurs due to the implication of the peritoneum.



Blood testing is usually of little value and can mislead the diagnosis. The base of diagnosing appendicitis remains the clinical exam done by the surgeon. But precisely the clinical examination can be sometimes mistaken as the variety of symptoms can mislead you easily.

Wrong interpretation of signs often makes a surgeon remove a normal appendix or delay the removal of a perforated one. Further complications like peritonitis, infection and longer hospitalization period needed, appear either due to late presentation of the patients in hospital or because of doctor's hesitation in establishing a diagnosis. Because of the dangerous sequels normal appendix removal must be avoided.

In the last two decades, certain new scoring systems have improved the clinical performances in establishing diagnoses although the general results were manifold. According to studies, mistaken diagnosis by young doctors has decreased from 42% to 29%, and perforation cases dropped by 50%.

The precision of medical conclusions increased though the new discovery more than due to the Alvarado scoring system that calculates the susceptibility of a person to develop appendicitis by several clinical references. The new technology using computers seemed to promise a most accurate diagnosis, but the normal appendectomy was still 15-30%.

In a study using ultrasonography combined with the Alvarado score, no major benefits occurred compared to the unassisted clinical judgment. Both camps showed an about 12 percent of mistaken diagnosis owed to normal appendix or late surgery of a perforated one. Echography, even when performed by most experienced clinicians gives a rate of 5% false positive diagnoses.

The question whether ultrasonography should be rarer used because of the cases that could have been better interpreted by clinical judgment, persists. The answer is dual, as ultrasonography sometimes proves itself vital when establishing a prompt diagnosis and thus reducing morbidity.

Recent research showed no necessity of routine ultrasonography in patients with clear signs of appendix inflammation, as it can only mislead surgeons by showing a false negative image. No clinical benefits can be provided by performing an echo to all hospitalized patients.

The importance of ultrasonography appears in uncertain cases and diagnoses, when the clinical judgment must be doubled by Para clinical technology. On the other hand a negative result from the Echography shouldn't make a doctor send the patient home; clinical abilities are still the most important in diagnosing.