OBJECTIVE: Missed cases of paediatric appendicitis lead to a delay in diagnosis and increased complications during the subsequent surgery. We aim to identify the common clinical features of such cases at the time of first hospital attendance. METHODS: Case records of patients with a missed diagnosis were reviewed retrospectively, documenting the presentation, preliminary investigations, initial diagnosis and eventual outcome. RESULTS: Thirty-nine patients fitted our criteria over a 2-year and

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... month period. The rate of "missed appendicitis" was 7%. The commonest symptoms and signs were that of nausea and vomiting (74.4%), abdominal pain (74.4%) and fever (61.5%). The site of abdominal pain was rarely in the right iliac fossa (5.1%). The two commonest diagnoses made at first presentation was that of gastroenteritis (51.3%) and constipation (25.6%). Twenty patients (51.3%) were initially discharged home. Compared to those initially admitted, more of those initially discharged home underwent surgery delayed beyond 24 hours from first presentation. CONCLUSION: The paucity of symptoms and signs in the right lower quadrant does not exclude appendicitis. Gastroenteritis and colic constipation are the greatest masqueraders of paediatric appendicitis. A high index of suspicion, therefore, is necessary to avoid wrongful discharge altogether. [Asian J Surg 2006;29(4):262-6]