The current study shows that patients who present with abdominal pain with no vomiting, guarding or raised white cell count are unlikely to have significant intra abdominal pathology and therefore can be considered for early discharge back to the community. Abnormal liver function test was helpful to point out the possibility of biliary colic, so was microscopic hematuria that may reflect urinary tract pathology.
Complaints of acute abdominal pain are common emergency department presentations. Many of these conditions prove to be benign and self-limiting illness, which has no clear explanation. Tenderness and peritonism in the right iliac fossa are not specific for appendicitis but may help to narrow the differential diagnosis in patients with right iliac fossa pain [6, 7]. However high WBC counts and left shift are strongly associated with appendicitis in children aged 1 to 19 years indeed for children older than 4 years with lower abdominal pain; the most common diagnosis in the setting of an elevated WBC count is acute appendicitis .
In females of childbearing age, the presence or absence of bilateral tenderness pain migration and vomiting may help to differentiate acute appendicitis from acute pelvic inflammatory disease  where patients tend to have raised white cells count and demonstrate signs of peritonism, which can make the differentiation between the two diagnoses on clinical grounds difficult. Mesenteric adenitis is very difficult to diagnose clinically and commonly patients undergo treatment for presumed appendicitis [10–12].
Imaging such as ultrasound  is helpful for detection of the cause of lower abdominal pain; in clinical centers where CT scan is routinely performed it reduces the rate of both negative appendicectomy and perforated appendicitis, whoever CT scanning has significant radiation dose for children and young adults [9, 14] and its not always practical or available. On the other hand elderly patients can have atypical presentations; vascular events are more common in this population, and a wide differential diagnosis needs to be considered .
Early diagnostic laparoscopy and treatment results in accurate, prompt, and efficient management of acute abdominal pain. This technique reduces the rate of unnecessary laparotomy and right iliac fossa gridiron incisions and increases the diagnostic accuracy in these patients; however this approach is expensive with significant use of the resources and potential morbidity . Diagnostic laparoscopy also avoids extensive preoperative investigations, averts delays in operative management . Morino et al assessed the role of diagnostic laparoscopy and concluded that laparoscopy compared with clinical observation, early laparoscopy did not show a clear benefit in women with non-specific abdominal pain. They reported higher number of diagnosis and a shorter hospital stay in the laparoscopy group [17, 18]. In another study patients who have no evidence of guarding, normal temperature, and normal white cells count were observed; a practice that is proven to reduce the rate of negative appendicectomy . Non-specific abdominal pain is the most common diagnosis in patients admitted with acute abdominal pain (25–35% of all patients), and of those patients only a quarter needs surgical intervention [2, 19]. Clinical scores that were developed to recognize acute appendicitis  are useful but those score could only be used with clinical judgment, if there is any suspicion of serious pathology the patient should undergo a diagnostic laparoscopy.
The current study shows the likely groups of patients with non-specific abdominal pain are those with normal white cell count, no history of vomiting and absent signs of peritoneal irritation with normal heart rate. Patients who fulfill those findings are suitable for early discharge, which may help to reduce the health care cost for those patients. All patients admitted to emergency department with abdominal pain should be referred for surgical opinion and the diagnosis of nonspecific abdominal pain should only be made after thorough assessment, definite pathology excluded and the patient does not return with the same complaint.