The message of Polly Gerber Zimmermann's informative article "Is It Appendicitis?" (Emergency, September) is that presentation can be nonspecific and accurate diagnosis difficult, leading to a "wait-and-see" approach of repeated assessments over time.

Because presentation is vague, it's important that we think of a differential diagnosis. Reproductive and urinary pathologies as well as gastrointestinal conditions can present similarly to acute appendicitis. It's particularly important to think about the possibility of a ruptured ectopic pregnancy, because waiting and seeing in this case could prove fatal.

Mary Gahbauer, MD

Westerville, OH

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