Diagnosis of acute appendicitis. Is physical examination enough to reach a surgical decision

: In the large majority of cases, acute appendicitis can be diagnosed on the basis of the medical history and the patient's symptoms. Urine should be drawn from every patient for urinstix and bacteriological testing, as well as blood for a blood count, electrolytes and coagulation parameters. A US should be performed, in particular to exclude possible other diagnoses. Women should be examined by a gynecologist. Once the diagnosis has been established, the patient must be sent for surgery without delay. Should there be reason for doubt, further diagnostic measures (in particular CT) should be carried out as permitted by the urgency of the case. In life-threatening situations, laparoscopy should be done immediately, and preparations made for laparotomy should this be necessary. If the symptoms are such that a wait-and-see attitude is justified, continued observation and follow-up examinations are recommended. The diagnosis of acute appendicitis can be difficult, and every patient who rouses relevant suspicion, should be seen by a surgeon.