الفهرس 
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Abstract
SUMMARY
Acute appendicitis is a disease with a lengthy documented history. The standard of treatment is well established and widely accepted. This disease remains one of the most common reasons for patients to seek medical assistance in the emergency department.
Clinical decision making in cases of acute appendicitis is still a matter of debate. The approach to the problem is further highlighted by the desire to reduce the rate of misdiagnosis, to avoid unnecessary surgery on one hand and to reduce the morbidity by operating at an early stage on the other hand. Those with the typical symptoms and signs of acute appendicitis, or suspected cases with definite findings of peritonitis are promptly indicated for surgery.
Looking at the statistics of appendicitis, it is evident that the diagnosis of appendicitis remains essentially clinical even in the presence of advanced imaging techniques.
In 1886, Reginald Fitz described the syndrome of acute appendicitis as a diagnostic and clinical entity, which required urgent surgical treatment.
The lifetime rate of appendectomy is 12% for men and 25% for women, with approximately 7% of all people undergoing appendectomy for acute appendicitis during their lifetime.
Any cause of acute abdomen can be considered in the differential diagnosis of acute appendicitis. A focused history and examination is vital in distinguishing appendicitis from other causes of lower abdominal pain.
However, Clinical decision making in cases of acute appendicitis is still a matter of debate. The approach to the problem is further highlighted by the desire to reduce the rate of misdiagnosis, to avoid unnecessary surgery on one hand and to reduce the morbidity by operating at an early stage on the other hand.
Those with the typical symptoms and signs of acute appendicitis, or suspected cases with definite findings of peritonitis are promptly indicated for surgery.
Equivocal cases usually require in-patient observation, multiple laboratory and imaging investigations, diagnostic laparoscopy and scoring systems.
The most prominent and most commonly used of those scores is that developed by Alvarado at 1986.
The Alvarado score is a cheap, reliable, and reproducible diagnostic tool which includes 8 variables: 3 symptoms, 3 signs and 2 laboratory data.
At 1994, Kalan et al omitted the parameter of left shift of neutrophil maturation and produced a modified score.
There are mixed results regarding the efficacy of modified Alvarado score.
The aim of the work was to evaluate the performance of MAS by measuring its sensitivity and specificity in the diagnosis of acute appendicitis.
This study included 150 patients with clinically diagnosed as acute appendicitis.
The patients were examined clinically and their MAS were calculated and listed. Any further required investigation was done and the decision to surgical treatment was based on the clinical judgment only.
All specimens of appendectomies were sent to histopathological examination and then their results were compared to the results of MAS.
The results showed that MAS at the cut-off value of ≥ 7 has a sensitivity of 93.33%, specificity of 52.94%, and accuracy of 84.42% and negative appendectomy rate of 12.5%.