BACKGROUND Acute appendicitis is the most common surgical emergency of the abdomen, but is still misdiagnosed in a large number of cases because of the the poor accuracy of the different radiologic and laboratory exams. Like in intestinal ischemia, an ischemic factor causes necrosis of the appendiceal wall and this favors the release of particular biochemical serum markers. OBJECTIVE To evaluate the efficacy of intestinal ischemia serum markers as a diagnostic test for acute appendicitis. METHODS Two hundred patients were studied prospectively. Depending on results of the examination by a surgeon, patients underwent surgery for acute appendicitis. Serum levels of amylase, lactic dehydrogenase, alkaline phosphatase, alanine transaminase, aspartate transaminase and leucocyte count were taken preoperatively. We then compared the results with histopathologic findings. RESULTS Appendicitis was confirmed in 176 patients. Leukocytes had the highest sensitivity but very low specificity. Amylase and DHL were very specific but their sensitivity was poor. Differential leukocyte count had the highest positive predictive value. CONCLUSIONS Serum enzymes of intestinal ischemia are not useful markers for the diagnosis of acute appendicitis. Leukocyte count is still the most useful serum marker of appendicitis.