Aim: With advent of Laparoscopy it was widely used for the treatment of acute appendicitis, As 
Laparoscopy has more exploratory scope than open surgery, the diagnosis and treatment of different causes 
of acute right iliac fossa pain can be done easily. The aim of this study is to determine the role of 
laparoscopy in justifying the differential diagnosis of clinically diagnosed acute appendicitis.
Methods: Between September 2003 and December 2008, laparoscopic appendectomy was attempted for 198 
patients complaining of right iliac fossa pain and diagnosed to have acute appendicitis, all data and 
operative findings were collected.
Results: There were 110 female and 88 male their ages ranged from 8-60 years old. Acute appendicitis was 
+ve in 155 patients (78.3%), it was +ve macroscopically in 116 patients, and was +ve histologically in another 
39 patients. Gynecological cause of abdominal pain was found in 22 females (11.1%). Mesenteric 
lymphadenitis was found in 4 (2%) cases and mesenteric ischemia in one (0.5%) patient. Omental infarction 
was found in 4 patients, 3 of them was acute and represented the cause of acute abdominal pain (1.5%). 
Normal laparoscopy was found in 13 patients (6.6%). 
Conclusion: These results emphasize the importance of considering omental infarction in the differential 
diagnosis of acute appendicitis.