A group of 98 patients with appendicitis with perforation was studied to determine symptoms and findings that might help predict perforation in patients suspected of having acute appendicitis. Management of appendicitis with perforation is outlined on the basis of the results in this series. The initial symptom was pain and tenderness in the right lower abdominal quadrant, and it occurred in 97 patients; there was nausea in 82, vomiting in 77, diarrhea in 19, and constipation in 13. Eighty-nine patients had fever, an elevated pulse rate, and an elevated leukocyte count. The duration of symptoms was not informative. The incidence of perforation was much higher in children than adults. There were 30 patients 10 years of age or younger, and 61 were 20 years of age or younger. The authors are inclined to advise immediate operation provided the patient is adequately prepared.