PURPOSE: We wanted to describe the characteristics of the malpractice claims related to acute appendicitis and to identify medico-legal problems and potential preventability of such claims. METHODS: A retrospective study was performed by reviewing the records at websites that furnishes judicial precedents. The records on closed malpractice claims involving acute appendicitis were abstracted from the files that were available for analysis. The records were reviewed and analyzed to determine the causes of the lawsuits, the pre- and post-operative diagnoses, the comorbid conditions of the patient, the causes of death or post-operative complications, the results of the lawsuits and the factors associated with a successful defense. RESULTS: Twelve closed claims involving acute appendicitis were founded in the malpractice data. Two claims were Supreme Court decisions and ten were district court decisions. The causes of lawsuit were categorized as follows: delay in diagnosis or operation, mistakes during operation, inappropriate management of postoperative complications and problems related to general anesthesia. 3 claims were assigned to each of the 4 particular causes of lawsuits. The most common causes of death were abscess with peritonitis and sepsis, and ten of which resulted in indemnity payments. CONCLUSION: Appropriate explanation and attention in the diagnosis/progress of appendicitis, getting an informed consent from the patient, the patients' comorbid conditions, early decision making in diagnosis/operation and proper care in the operation were critical for preventing lawsuits related to acute appendicitis.