The Prospective Study to Evaluate the Efficacy of ALVARADO Score and RIPASA Score in Diagnosis of Acute Appendicitis and Correlation with Histo- Pathological Findings

Background: Acute abdomen is one of the most common surgical emergencies with the life time risk of 7%. The diagnosis of appendicitis is challenging due to overlapping of symptoms with other diseases and variable accuracy of clinical examination. The present study was carried out to diagnose acute appendicitis and its complications, to compare ALVARADO and RIPASA scoring systems and correlating these with intra-operative and histopathological findings. Methods: This prospective study of 100 patients was conducted in Department of Surgery admitted in Muzaffarnagar Medical College and Hospital, Muzaffarnagar. Any patients irrespective of sex admitted with age more than 13 yrs presented with right iliac fossa pain suspected to be acute appendicitis and underwent appendectomy. Diagnosis of acute appendicitis was confirmed by operative findings and histological assessment of the appendectomy specimen. In every clinically diagnosed case, ALVARADO and RIPASA scoring systems were applied. Patients were monitored following admission, surgery and till discharge from the hospital. Intra-operative findings such as length of appendix, site of appendix, presence of gangrene or nor, free fluid present or not, presence of fecolith or not, base of caecum evaluated. Histopathologic findings of operated case were collected and correlated with either scores. Results: Out of 100 patients 64% were males and 36% were females. When Alvarado score applied in the study group; 55 patients were in > 7 group and 45 patients in < 7 group. When correlate with histopathology, 90% patients fall into acute appendicitis group and 10% in nonappendicitis group. RIPASA score revealed that there were 89% patients in high probability of acute appendicitis, while 11% were in low probability. When correlate with histopathology 90% fall into appendicitis group and 10% in non-appendicitis group. Conclusion: In the study we conclude that for the diagnosis of appendicitis both ALVARADO and RIPASA scoring systems were equally good. However, RIPASA score is a useful rapid diagnostic tool for establishing a quick decision in patients with RIF pain. Moreover, it also reduces the cost of expensive radiological investigations and thus making a more cost effective approach for patients belonging to lower socioeconomic group

Urinoma: a rare complication of ureteral calculi.

Urinoma is a collection of extravasated urine either in renal subcapsular or perirenal space. It is caused by obstructive and non-obstructive pathologies. It is rare; with trauma as most common cause in adults and ureteral stones as least common. It mimics symptoms of ureteral stone. CT KUB is best modality to detect it. Here we present a case of ureteral calculi leading to urinomas formation in a 42 years old male patient present with retention of urine and pain in left flank region with nausea, vomiting and fever.