Diagnostic Difficulties

Table 1: Difficult diagnostic groups in patients with suspected appendicitis
Group	Difficulty
Children	Atypical symptoms and signs can lead to late presentation
Elderly	Atypical symptoms and signs can lead to late presentation and 3x increased perforation rate
Pregnant patients	Abnormal position of the appendix due to pregnant uterus can cause atypical signs, perforation associated with foetal mortality
Abnormal positioning of the appendix	Atypical site of pain, e.g. with pelvic appendix
Women of child-bearing age	Extensive differential diagnosis including tubo-ovarian pathologies, higher rates of negative appendicectomies

96% of patients will have RIF pain, however, atypical pain and diagnostic difficulties are common in the groups in the table.

Learning-bite

Maintaining a high index of suspicion in these diagnostic groups may help to prevent missing appendicitis diagnosis.