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OBJECTIVE The aim: To search for new and improvement of known methods of diagnosis and surgical treatment of atypical forms of acute appendicitis. PATIENTS AND METHODS Materials and methods: There were analyzed the results of diagnosis and surgical treatment of 852 patients with atypical course of acute appendicitis, which amounted to 25.3% of the total number of patients in this category. Depending on the chosen diagnostic and treatment tactics, patients with acute atypical appendicitis were divided into two groups: control (n=423) and main (n=429). RESULTS Results: It was found that among atypical forms of acute appendicitis retrocecal location of the appendix is 61.2% of cases, pelvic - 24.3%, medial - 11.2%, subhepatic - 3.4%. Destructive forms of atypical acute appendicitis occurred in a total of 92.5% of cases, 77.7% of patients had various types of peritonitis. CONCLUSION Conclusions: Authors improved and tested a number of diagnostic (rectal thermometry, ethanol test) and operative methods for destructive forms of acute appendicitis complicated by typhoid (including laparoscopic). The proposed diagnostic and treatment algorithm allowed to optimize the treatment tactics of this category of patients and reduce the incidence of complications in the early postoperative period from 9.9% to 3.5% (p<0.001).