Abstract
Despite the advances in surgery over the past century, the diagnosis of acute appendicitis continues to present clinicians with problems. As Rao et al. report in this issue of the Journal, as many as 47 percent of clinical diagnoses of acute appendicitis are wrong,1 for a variety of reasons. The assessment of pain is notoriously difficult; some patients hardly seem to notice pain, and others are extremely sensitive to it. To make matters even more complicated, there are probably few patients who have not at some time in their lives simulated pain in the abdomen to avoid some obligation, such . . .