The Roles of USG and NCCT in the Diagnosis of Acute Appendicitis: A Study in a Tertiary Care Center in North Eastern India.

Background: Acute appendicitis is a common cause of hospital admission and emergency laparotomy among children and young adults. Although the diagnosis is clinical, the use of radiological imaging has emerged over the past decades. Its principal use is as a problem-solving tool in equivocal cases. Owing to the increased use of imaging in the last few years, the negative appendicectomy rate has dropped significantly. In this prospective observational study, we compared the diagnostic accuracy of Ultrasonography and Non-Contrast Computed Tomography. Method: One hundred and eighteen patients with clinically suspected appendicitis followed a designed protocol. Patients underwent appendicectomy after a first performed positive ultrasonography or after a positive Non-Contrast Computed Tomography when Ultrasonography was equivocal or nonspecific. When any other diagnosis was apparent in either imaging modality which could explain the symptomatology in the patient, they were considered negative for acute appendicitis and treated accordingly. Results: The respective sensitivity, specificity, and accuracy for Ultrasonography, Non-Contrast Computed Tomography, and the whole diagnostic pathway for the diagnosis of acute appendicitis were 70.73%,80.83%, and 78.54; 100%,100%,100%, and 83.6%; and 100%,83.33% and 94.92%. Conclusion: Using Ultrasonography as the first-line diagnostic tool and Non-Contrast Computed Tomography as a complementary second-line diagnostic tool, appendicitis can be diagnosed with high accuracy and the negative laparotomy rate can be brought down significantly without any increase in the risk of complications. Computed Tomography is superior to Ultrasonography for the diagnosis of acute appendicitis.

Recurrent aggressive angiomyxoma of the vulva - a rare presentation.

We describe here a case of a 38-year-old lady presenting with a about 5x4cm in size swelling on the left labia majora. She had similar type of swelling 2 years back which was treated surgically. FNAC report of the present mass revealed angiomyxoma. In view of its' recurrent nature wide local surgical excision of the mass was done. Histopathology report confirmed the diagnosis of angiomyxoma. The lady is under follow up and there is no further recurrence till date.

An unusual branch of celiac trunk feeding suprarenal gland - a case report.

During routine dissection, variation in branching pattern of coeliac trunk has been observed in adult 54-year-old male cadaver. Instead of normal three branches an additional branch i.e., Left inferior phrenic artery originated from it as fourth branch. Then it divided into two branches, one directly supplied the diaphragm and other branch divided into three sub-branches. First and second branch entered into the left suprarenal gland at its upper and middle pole and third one finally terminated by supplying to the diaphragm. There is no separate middle suprarenal artery on the left side, but inferior suprarenal artery was as usual. No variations have been found on right side in the lateral branches of abdominal aorta. Such a quadrifurcation of celiac trunk to supply suprarenal gland is quiet unique so far searched in literature.