[Acute appendicitis: can diagnosis and surgical indications be more precisely ascertained?]

Of 408 patients hospitalized for suspected appendicitis, 347 underwent appendectomy. 20.5% of the appendices removed were gangrenous or perforated, while 19.8% showed no acute inflammation. Retrospective analysis of the data collected from all of the 347 patients who underwent surgery and a review of the literature suggest that the following measures could contribute to a lowering of both perforation rate and rate of negative laparotomies: (1) Reconsideration of present concepts on the clinical picture of acute appendicitis and a more precise definition of the terms used. (2) Improved methods of history-taking and examination of patients. (3) More complete recording of the data collected in every case of suspected appendicitis, (4) Intensive in-hospital observation for a short period of time. (5) Laparoscopy in cases which remain doubtful.