الفهرس 
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Abstract
acute appendicitis is one of the most common problems requiring emergency surgery. it has been estimated that the accuracy of the clinical diagnosis of the acute appendicitis is only between 75-90 %. thus, accurate diagnosis of acute appendicitis is still difficult. this study was aiming to examine the value of clinical, laboratory and laparoscopic diagnosis in the management of patients with acute right lower abdominal quadrant pain who were suspected to have acute appendicitis. thirty patients (18 females & 12 males) were the material of this study . their main age was 3.8 ± 7.28 years. clinical assessment stressed upon the type, site and duration of the presenting abdominal pain, other gastrointestinal, urological and gynecological symptoms, clinical signs namely pulse, temperature, abdominal guarding, rigidity, tenderness and rovsing?s sign. laboratory assessment was done for all the study patients including white cell count, total differential count and c- reactive protein beside the routine ones . we believe with these laboratory diagnostic tools available today the negative appendectomy rate could be significantly reduced without increase the risk of perforation . if these tests are normal , the surgeon should preferably refrain from surgery and consider other differential diagnosis. to increase the validity of the c- reactive protein in diagnosis of acute appendicitis. combine it with tlc and differential count, so called triple test is used. all the study patients underwent laparoscopic examination after clinical and laboratory assessment. the laparoscopic diagnosis was supportive and confirmative to the clinical diagnosis . final diagnosis was made based on laparoscopic diagnosis together with histological examination of the removed specimen. diagnostic laparoscopy was able to settle the correct diagnosis in 29 patients with high diagnostic accuracy(96, 6%). also was able to save patients from unnecessary explorations. there was one patient (3. 3%) who developed internal haemorrhage that easily controlled after conversion to open procedure(3. 3%). l. a. required operative time which is not significantly different from open procedures. it is expected that with increased experience, the operative time will decrease. there was insignificant postoperative symptoms; pain, nausea and ileus . regular diet was tolerated early. there were minimal postoperative wound infections in 4 cases(13. 3%) and there was one case of intra-abdominal abscess formation in this study that treated conservatively. conclusion: clinical diagnosis and laparoscopy were complementary in diagnosis of acute appendicitis and their combination was able to settle the diagnosis in most of the patients with acute right lower abdominal pain. laparoscopic assessment was advantageous in cases of diagnostic uncertainty; and we recommend judicious use of laparoscopy to decrease the negative laparotomy rate for acute abdominal syndromes. la caused fewer complications, diminished pain, shortened convalescence, decrease wound infection rate and modestly reduced hospital stay but , insignificantly different from oa so, la was not superior on oa. removal of an apparently normal appendix if no other pathology is found at laparoscopy was recommended to avoid further postoperative confusion if symptoms recur, to prevent progression of subclinical appendicitis in the postoperative period . good surgical judgment was the key of safe performance of laparoscopic surgical procedure. the decision of laparoscopic appendectomy for acute appendicitis may have to be determined by the individual preference of patients and surgeons, and depending on the resources available. our recommendation is ; the study has to be extended due to small number of patients , building-up of technique mastering and short- term follow up