Acute appendicitis remains a diagnosis based primarily on the history and the physical examination performed by an experienced surgeon. Ultrasonography and CT can be an useful adjunct, but they should not be used without context to the clinical picture. In therapy, open appendicectomy remains the golden standard. Laparoscopic appendectomy is reserved for special situations. Preoperative ultrasound is useful to decide upon the operative procedure. When the clinical picture and ultrasonography reveals acute appendicitis one can expect a minimal negative appendectomy- and laparotomy rate of 2.7% and 2.1%. In these situations open appendectomy is indicated. In the case where ultrasonography reveals no appendicitis, negative appendectomy rate is 31%. In this situation further abdominal exploration and thus diagnostic laparoscopy and laparoscopic appendectomy is indicated.