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Background and Aim: Appendicography had been used in the diagnosis of chronic appendicitis. To our knowledge, the role of endoscopic retrograde appendicography for the diagnosis of acute appendicitis remains unknown. The aim of this study was to evaluate the role of endoscopic retrograde appendicography for the diagnosis of acute appendicitis.Patients and Method: Patients with suspected acute appendicitis between December 2013 and November 2015 at Second Affiliated Hospital of Harbin Medical University underwent endoscopic retrograde appendicography. The findings and complication were analyzed retrospectively.Results: Thirty-three patients (20 men and 13 women, average age 44 ± 18 years) with suspected acute appendicitis were studied. Acute appendicitis was ruled out by normal endoscopic retrograde appendicography in 24% and confirmed in 69.6% (23). In 2 patients (8%) appendiceal orifice cannulation failed. Colonoscopic findings in acute appendicitis were mucosal hyperemia and edema of appendiceal orifice (83%), outpouring of pus from the appendiceal orifice (74%), and swollen cecal mucosa (61%). Appendicograpic findings were either normal or in acute disease showed diffuse lumenal dilation (diameter: 0.8 ± 0.4 mm), partial stenosis (43%), stiffness or inflexibility (87%) and filling defects (22%). There were no complications during or after follow-up for a median of 13 months (IQR: 9-24 months).Conclusions: Endoscopic retrograde appendicography appears to be a reliable and safe method to confirm or exclude the diagnosis of acute appendicitis and prevent unnecessary appendectomy.