Atypical clinical presentation of acute appendicitis: diagnostic challenges

Acute appendicitis remains one of the most common causes of surgical emergencies. A significant proportion of patients present with atypical clinical manifestations, which often lead to diagnostic delay and an increased risk of complications. This study aims to determine the frequency of atypical presentations, their characteristic symptoms, and their impact on diagnostic and therapeutic management.Materials and Methods: A retrospective study was conducted on 124 patients who underwent surgery for acute appendicitis at the Department of General and Hepato-Pancreatic Surgery, University Hospital “Alexandrovska,” between 2018 and 2025.Of 124 patients, 38 were men (30.6%) and 86 women (69.4%), with a mean age of 37.7 years. Results: Atypical clinical presentation was observed in 34 patients (27.4%). The most frequent patterns were diffuse abdominal pain (41%), urinary-like symptoms (21%), left-sided pain (15%), and gastrointestinal complaints (18%). The mean diagnostic delay in the atypical group was 19 hours, compared with 7 hours in the typical group (p < 0.05). Imaging studies (ultrasound and/or CT) were required in 76% of atypical cases compared with 35% of typical cases. Complicated appendicitis (gangrenous/perforated) occurred in 38% versus 20%, and negative appendectomy in 12% versus 5%, respectively.Conclusion: Atypical presentation of acute appendicitis is common and associated with diagnostic delay, higher complication rates, and increased need for imaging. Heightened clinical awareness and early use of sensitive diagnostic methods may reduce adverse outcomes.