Suspected appendicitis in childhood obesity is associated with increased incidence of normal appendectomy. Active observation in hospital in very obese children may reduce the rate of normal appendectomy without increasing the incidence of complicated appendicitis.

Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in extremely obese children.

CRP is not a reliable marker of inflammation in extremely obese children presenting with suspected appendicitis. Our data highlight the importance of obesity when interpreting the significance of an elevated CRP level in children with suspected diagnosis of appendicitis.