Key Clinical MessageAlthough there are many causes of pain right lower abdomen, stump appendicitis should always strike a clinician in postappendectomy patients even if it is a rare diagnosis. Here, we are discussing a 35‐year female with stump appendicitis who underwent completion appendectomy.

Background: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. Objective: To determine the relative prevalence of histologically proven acute appendicitis in surgically respected specimens with clinical diagnosis of acute appendicitis and also to find out the rate of occurrence of characinoid tumour as an incidental histologic finding.Methods: It is a retrospective study involving all gross specimens received in the department of pathology over a period of twenty months (1.1.2006 to 31.8.2007). Histologic data on 515 appendicectomy samples (clinically diagnosed as appendicitis) of the total 7295 specimens received over a period of twenty months were retrieved from the archives of department of pathology, with exclusion of appendectomy incidental to another surgical procedure.Results: Appendectomy specimens constituted 7.0% (n=515; M:F 1.1:1) of all surgical pathologic specimens (n=7295) at B.P.K.I.H.S. The breakups of histologic diagnoses are: acute appendicitis with or without periappendicitis and gangrenous change (93.6%, n=482), “receding appendicitis” (5.4%, n=28), and normal histology (1.0%, n= 5). Carcinoid tumours were detected incidentally in three cases (0.58%) out of all appendectomy specimens.Conclusion: Analysis of data revealed a prevalence of 6.99% of histologically proven acute appendicitis in this tertiary health care set up. The rate of occurrence of carcinoid tumour was 0.58%.Health Renaissance 2014;12(3): 197-203

Background: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention.Objectives: To determine the relative prevalence of histologically proven acute appendicitis in surgically resected specimens with clinical diagnosis of acute appendicitis and to find out the rate of occurrence of carcinoid tumour as an incidental histologic finding. Methods:Type of study-descriptive study Study unit-all gross specimens received in the department of pathology over a period of twenty months (1.1.2006 to 31.8.2007) Study sample-Histologic data on 515 appendicectomy samples (clinically diagnosed as appendicitis) of the total 7295 specimens received over a period of twenty months were retrieved from the archives of department of pathology, B. P. Koirala Institute of Health Sciences (BPKIHS).Exclusion criteria-appendectomy incidental to another surgical procedure. Results:Appendectomy specimens constituted 7.0% (n= 515; M:F 1.1:1) of all surgical pathologic specimens (n= 7295) at BPKIHS. Following is the breakup of histologic diagnosis: acute appendicitis with or without periappendicitis and gangrenous change (93.6%, n= 482), receding appendicitis (5.4%, n= 28), normal histology (1.0%, n= 5). Carcinoid tumours were detected incidentally in three cases (0.58%) out of the total number of 515 appendectomy specimens.Conclusion: Analysis of data revealed 1. A relatively higher prevalence (6.99%) of histologically proven acute appendicitis in this Tertiary health care set up compared to similar data reported in the literature. 2. Rate of occurrence (0.58%) of carcinoid tumour as incidental finding is similar to that reported in the literature.

Background: The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. The aim of the study was to compare the clinical judgment of surgeons and Alvarado score in diagnosing acute appendicitis within Nepalese people and to refine the score and suggest a new score to make a more accurate diagnosis of acute appendicitis.Methods: In this prospective, parallel-group, quasi-randomized study of patients presenting at a tertiary hospital in eastern Nepal with suspected appendicitis during 1 year were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients based on the clinical judgment. The correctness of the methods was assessed by the final histology.Results: In this study, the mean age of patients in Alvarado group was 26.45 years and in clinical judgment was 28.68 years. The sensitivity, the specificity, the diagnostic accuracy, the positive predictive value and negative appendectomies in Alvarado group were 95.5%, 68.9%, 90.91%, 93.4% and 6.56% respectively whereas in clinical judgment group were 98.51%, 85.71%,496.4%, 97.04% and 3.59% respectively.Conclusions: This study showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation.

Background and Objectives: Although surgery is the gold standard treatment for anal fissure, the main concern remains its side effects and complications in terms of permanent incontinence. In recent years, treatment of chronic anal fissure has shifted from surgical to medical. This study compares the efficacy and safety of two non-surgical treatments-botulinum toxin (BTX) injection with nitroglycerine (NTG) ointment for the treatment of chronic anal fissure. Methods:One hundred and twelve adults were assigned randomly to receive treatment with either type A botulinum toxin (15 units) injected into internal anal sphincter or 0.2% nitroglycerine ointment applied thrice daily for 8 weeks.Results: After 2 months, the fissures were healed in 50 (89.3%) of 56 patients in botulinum toxin group and in 39 (69.6%) of 56 patients in nitroglycerine group (P= 0.01). Seventeen (23%) patients in nitroglycerine group complained of headache while none of the patients in botulinum toxin group had any forms of adverse effects. The recurrence rate of nitroglycerine group was higher than botulinum toxin group at 3 months (4.3% in BTX vs 16.7% in NTG, P = 0.057) and at 6 months (8.5% in BTX vs 36.1% in NTG, P = 0.002). Conclusion:Although treatment with either topical nitroglycerine or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective option.