RIPASA score: a new diagnostic score for diagnosis of acute appendicitis

To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Cross-sectional study. Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age [less than 40 years = 1 point; greater than 40 years = 0.5 point], gender [male = 1 point; female = 0.5 point], Right Iliac Fossa [RIF] pain [0.5 point], migration of pain to RIF [0.5 point], nausea and vomiting [1 point], anorexia [1 point], duration of symptoms [less than 48 hours = 1 point; more than 48 hours = 0.5 point], RIF tenderness [1 point], guarding [2 points], rebound tenderness [1 point], Rovsing's sign [2 points], fever [1 point], raised white cell count [1 point], negative urinalysis [1 point] and foreign national registration identity card [1 point]. The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Out of 267 patients, 156 [58.4%] were male while remaining 111 patients [41.6%] were female with mean age of 23.5 +/- 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain

Gall stone ileus: a rare cause of small bowel obstruction

Gallstone ileus is a rare disease and accounts for 1-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We present a case report of a 55 year old lady diagnosed as having gall stone ileus and was treated with emergent laparotomy and enterolithotomy with fistula repair at a later stage