Background and Objective: In the present study, the diagnostic agreement between surgical and pathological findings of appendicitis in children was tested. The aim was to assess the association between patient body mass index (BMI) and this diagnostic agreement.

Methods: This cross-sectional study was carried out on 121 consecutive children aged less than 15 years suspected to acute appendicitis that were candidate for appendectomy in surgery ward of Ali-Asghar hospital between 2006 and 2011. The patients’ characteristics were collected from hospital recorded files.

Results: Assessment of surgical and pathological findings showed a good agreement between the two procedures with an agreement value of 0.69. The overall prevalence of obesity in those with and without pathological appendicitis was 8.7% and 21.5% with a significant difference between them (p= 0.012). Also, the mean BMI in patients with surgical appendicitis was 19.6 ± 4.9 kg/m² and in those with normal appendix was 20.9 ± 4.8 kg/m² that was significantly lower in former group (p= 0.041).Thus, the mean BMI in patients with appendicitis diagnosed surgically or pathologically was lower than those with normal appendix.

Conclusion: Obesity is more common in children with normal appendix surgically and/or pathologically.  Thus, the over diagnosis of appendicitis is higher in obese children