Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate?

Laparoscopy has been performed in 32 patients in whom the diagnosis of appendicitis was suspected, but in whom clinical findings were equivocal and insufficient to establish the diagnosis. These patients represented 13.6% of the total group of patients admitted with questionable appendicitis during this period. Fifty per cent of these 32 patients had unusual clinical features, such as a prolonged history of symptoms, significant intercurrent disease, prior treatment with antibiotics or steroids, etc. At laparoscopy, the diagnosis of acute appendicitis was made in 17 patients. Another disease was diagnosed in 8 patients, and 7 were judged to have no pathologic abnormalities. There were two false negative examinations and one false positive, but no ruptured appendices resulted. Twelve patients (37.5%) were spared operation by laparoscopy. The negative appendectomy rate was decreased from 10 to 1%.