During the last 11 years, 122 children aged less than 5 years underwent appendectomy with a preoperative diagnosis of acute appendicitis.At surgery, 29 children (24%) presented with acute suppurative appendicitis, 64 children (52%) perforated appendices and 26 children (21%) with appendiceal abscess.In three cases (2%) there was no acute intra-abdominal process.In this study the following data were analysed: age, gender, symptoms, duration of symptoms, whether seen by a physician prior to admission and surgery, physical findings, stage of the disease at operation, histology, postoperative complications and mortality.Conclusion: The accurate diagnosis in early childhood appendicitis is still a difficult matter.The responsibility of the paediatric surgeon is mainly the clinical examination with all his clinical skills and facilities and if serious doubt still exists, to proceed with a laparotomy in order to reach a definite diagnosis. Of the last 11 years, 122 children aged less than 5 years underwent appendectomy with a preoperative diagnosis of acute appendicitis. At surgery, 29 children (24%) presented with acute suppurative appendicitis, 64 children (52%) perforated appendices and 26 children ( 21%) with appendiceal abscess.In three cases (2%) there was no acute intra-abdominal process.In this study the following data were analyzed: age, gender, symptoms, duration of symptoms, whether seen by a physician prior to admission and surgery, physical findings, stage of the disease at operation, histology, postoperative complications and mortality. Conclusion: The accurate diagnosis in early childhood appendicitis is still a difficult matter. The responsibility of the pediatric surgeon is mainly the clinical examination with all his clinical skills and facilities and if serious doubt still exists, to proceed with a laparotomy in order to reach a definite diagnosis.