Acute appendicitis is the most important cause of abdominal pain in children and is the commonest that requires emergency surgery. Prompt diagnosis, immediate referral and expeditious surgery should be undertaken to reduce the risk of a perforated appendix. The initial presentation may be atypical or be similar to another pathological process which makes the diagnosis extremely difficult. Risk assessment forms an important part in the management of these cases. We consider the difficulties in making the diagnosis including: (A) the pitfalls of clinical examination; (B) the usefulness of laboratory testing; (C) the relevance of clinical scoring systems; and (D) the controversial issue of imaging.
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