The role of imaging in acute appendicitis and the need for histopathologic validation

With increasing availability of diagnostic imaging, the workup and treatment of appendicitis is shifting from a settled disease process to one of controversy. As appendicitis is the most common surgical disease, its workup must be efficient, cost effective, and accurate. The presentation of fever, leukocytosis and right lower quadrant pain is a common presentation for a patient taken to the operating room for appendectomy. However, we know from decades of research, using clinical examination alone, the negative appendectomy rate can be as high as 20% which has historically been the acceptable negative appendectomy rate. Is this still acceptable?