This is a result of the need for early diagnose and treatment to achieve less perforation rate and complication [2]. In this study all 196 patients were demonstrating positive symptoms and physical signs for appendicitis. White blood cell counts were high for the 80% of the patients. Elangovan et al found high levels of white blood cell count in AA patients 80 percent [3]. Unfortunately, the white blood cell is elevated in up to 70 percent of patients with other causes of right lower quadrant pain [4]. NAR were 13.4% and 32.5%

in the patients who had high and normal white blood cell counts, respectively. We found our NAR as 17.3%. Buparlisib Kyuseok et al studied 339 patients in two groups as preoperative no imaging and imaging studies find more and they found their NAR as 20.6 percent and 6.6 percent [5]. Hassan et al

found, being younger than 21 years old, female gender, lower levels of polymorphonuclear leukocyt and lower heart rates as a risk factor for negative appendectomy [6]. Singhal et al showed 18.2 percent NAR for males and 48.2 for females at their study group [7]. Our NAR was 11.5 percent for male patients and 27 percent for females. Radiology with the help of improving technology gets more space in the diagnose and differential diagnose for acute abdomen patients. We used USG for 196 suspicious acute appendicitis patient and found ultrasonography had a sensitivity of 71.6% and a specificity of 58%. The predictive value of a positive test was 89% and the predictive value of a negative test was 30%. Rajeev gave this ratios at his study on 118 preoperatively USG performed appendectomy patients as 63.3%, 82.14%, 91.93% and 41.07% [8]. Another study comparing 200 USG negative patients to 200 USG positive, NAR was found 4.7% for positive group [9]. Suma Metalloexopeptidase evaluated 1447 suspicious acute appendicitis patient with USG, 368 (25%) were positive for appendicitis and 7 were false positive. Remaining 1079, 173 patients (12%) had an other diagnose due to USG and 906 patients’

complaints regressed during follow up. This study gave a sensitivity and specificity of 98% and 99%. The predictive value of a positive and negative test were 98% and 99% with %99 overall diagnostic accuracy [10]. Difficulties with ultrasonography include identification of normal appendix to rule out acute appendicitis. Visualization of a normal appendix is more difficult in patients with a large body habitus and when there is an associated bowel obstruction, which causes overlying gas-filled loops of bowel. Accuracy of ultrasonography also decreases with retrocecal location of the appendix. Meckel’s diverticulum, cecal diverticulitis, inflammatory bowel disease, pelvic inflammatory disease, and endometriosis can cause false-positive ultrasound results. Patients often complain of the pressure during evaluation.