The most common surgical emergency is suspected acute appendicitis, the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women, with a male to female ratio of 1.4:1; correct diagnosis can be made in 70-80% of patients after the operations about 32% of appendectomies revealed normal appendices and meanwhile appendectomy has a considerable morbidity and mortality. The aim is to explore potential morbidity and mortality associated with negative appendectomy. Prospective case series study, including 5847 patients, who were suspected to have acute appendicitis over a period of five years from 1st December 2013 to 30th November 2018, in emergency department of Sulaimani Teaching Hospital. All the collected data were collected, organized then analyzed by Statistical Package for the Social Sciences version 21. Morbidity in the patients with negative appendectomies occurred in patients in the form of 90 (01.91%) wound infection, 48 (01.02%) intestinal obstruction and last 15 (00.32%) patients developed septicemia. While mortality in negative appendectomy patients was 21, (00.45%). Negative appendectomies have high rates of morbidity and mortality, knowing real rates may help in considering various policies and may be helpful to elude avoidable complications and potential mortality. Non traumatic acute abdomen is 4-8% of adults admitted to the emergency department 1,2. The most common surgical emergency is suspected acute appendicitis, "the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women" 3. Males are affected one and half more times than females 4 while definite diagnosis could be done in 70-80% of patients 1 , after the operations about 32% of appendectomies revealed normal appendices 5 , In females of child bearing age, gynecological pathologies are simulating acute appendicitis 1 , which may increase the prevalence of negative appendectomies. Clinical suspicion of acute appendicitis is mostly done on patient's symptoms and physical findings, including Alvarado score "which has adding accuracy (98.60%) versus computerized tomography (CT) scan (99.03%) 6. Although laboratory blood and urine investigations and simple imaging like plain erect abdominal radiogram and ultrasonography of abdomen and pelvis may aid in accuracy of the diagnosis. "But are not as helpful as magnetic resonance imaging (MRI) and CT scan, which have accuracy of 98% in diagnosing acute appendicitis and lastly diagnostic laparoscopy" 1,3,7-10 .

IntroductionHypertensive intra-cerebral hemorrhage is usually a one-time event and recurrences are rare. Most recurrences develop as part of long-term failure of blood pressure control. The site of the re-bleed is usually limited to the basal ganglia and thalami.Case presentationWe report the case of a 59-year-old hypertensive Caucasian woman who developed two sequential, right- and then left-sided, deep cerebellar hemorrhages. The second hemorrhage followed the first one by 57 days, at a time when her blood pressure was optimally controlled. In spite of these critical sites and short duration between the two bleeds, the patient achieved a relatively good functional recovery. Her brain magnetic resonance angiogram was unremarkable.ConclusionThe development of recurrent hypertensive hemorrhage is rare and usually occurs within two years of the first bleed. To the best of our knowledge, this is the first reported case of bilateral, sequential, right- and then left-sided deep cerebellar hemorrhages. These hemorrhages were separated by eight weeks and the patient had a relatively good functional recovery. We believe that hypertension was the etiology behind these hemorrhages.

Background: The appendiceal disease is one of the most common reasons for emergency hospital admission, and appendectomy is one of the most frequently performed emergency procedures. Obstruction of the appendiceal lumen is the usual cause of acute appendicitis. However, in elderly patients, it may also be due to a neoplasm of appendix, cecum, or even colorectal carcinoma and appendicitis can be its first manifestation. Of all the gastrointestinal tract malignancies, colorectal carcinoma is the most common one. Objective: To find the incidence of the carcinoma of colon in patients above 40 years of age who underwent appendectomy. Methods: Two groups of patients studied from Sulaimani Teaching Hospital and Kurdistan Center for Gastroenterology and Hepatology. Both groups underwent colonoscopy and one group only had appendectomy. Non-appendectomized group used as control. A 213 patients from a total of 545 patients studied from October 1st, 2018 to September 30th, 2019. Results: More than half of the patients (54%) had normal colonoscopy, others showed internal hemorrhoid (15.5%), polyp (15%), sigmoid mass (0.9%), rectosigmoid mass (0.5%) and gastrointestinal stromal tumor (0.5%). Histopathology results were tubular adenoma with low-grade dysplasia (36.4%), hyperplastic polyps (34.1%), adenocarcinoma (2.3%), and familial adenomatous polyposis (2.3%). Conclusion: The incidence of colorectal carcinoma is 4.76% in the studied group whom underwent appendectomy after 40 years of age. Keywords: Acute appendicitis, adenocarcinoma, colonoscopy, colorectal cancer, mucinous neoplasm of appendix, appendectomy. Citation: Faraj FH, Abdulla AA, Abdulqader GMR, Mardan ME, Mohammed SA, Mahmood MMS, Hussein SA, Shareef WOH. Incidence of colorectal carcinoma in patients undergoing appendectomy after age of 40 years in Sulaimani Teaching Hospital. Iraqi JMS. 2021; 19(1): 24-32. doi: 10.22578/IJMS.19.1.4