[Diagnosis of appendicular syndromes: for a rational approach]

Diagnosis of acute appendicitis is made in 80% of cases by analysis of symptoms and physical examination. Epigastric pain, secondary located in the lower quadrant, along with tenderness is the most specific sign of acute appendicitis. In 20% of cases, diagnosis is difficult. High level of leucocytosis is not of great value. Laparoscopy has been proposed to visualize the appendix. Echotomography and tomodensitometry are less invasive and less costly procedures, that let surgeons identify the appendix and confirm or reject the diagnosis of acute appendicitis. Thus, surgical acts should be restricted to necessary appendicectomies.