INTRODUCTIONReginald Fitz from Boston first identified inflammation of the appendix as a cause of right lower quadrant pain. He coined the term appendicitis and recommended early surgery intervention. Robert Lawson performed first appendectomy in England.1 Now 130 years later, acute appendicitis still remains one of the most common abdominal emergency, demanding surgery. Mortality rate has improved since advent of antibiotics in 1940. No perfect diagnostic evaluation tool exists to detect appendicitis if symptoms are ambiguous. If symptoms are vague diagnostic process takes longer, thus delaying surgery increasing the possibility of complications. On the other hand, hasty operation without accurate diagnosis will lead to negative appendectomy, increasing the morbidity and cost of treatment. 2,3Even with the advent of modern diagnostic tools, misdiagnosis of appendicitis has remained more or less constant. The percentage of misdiagnosis is higher among women than men. Diagnostic approaches include symptomatology, physical examinations, laboratory findings and imaging modalities like ultrasonography and computerized tomography (CT) of abdomen. Although the advent of ultrasound has improved the diagnosis of ABSTRACT Background: Acute appendicitis is one of the most common surgical emergencies encountered by doctors on call with emergency appendicectomy being a very common outcome of emergency laparotomies. There's been a marked decline in mortality over the past 50 years, but the rates of perforation and negative laparotomy have not changed much as they're influenced by factors untouched by technological advances. Methods: A prospective comparative study to compare appendicitis inflammatory response score (AIR) and Alvarado scoring systems in evaluating suspected cases of acute appendicitis. 100 patients presenting with pain in the right lower quadrant of abdomen at the surgical clinics at Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka, India, who after clinical examination and relevant investigations were provisionally diagnosed to have acute appendicitis and warranted surgery for the same were evaluated using the scoring systems -Alvarado Score and Appendicitis Inflammatory Response Score. The scores were tallied and compared with final histopathology report. The study was conducted for a period of one and a half year. Results:The results revealed that AIR (at score >4) demonstrated a higher sensitivity and specificity compared to Alvarado score (89.9 versus 78.6%) and (63.6 versus 54.5) respectively. Alvarado showed a slightly better sensitivity at score>8 (21.3 versus 12.3%). Conclusions: The Appendicitis Inflammatory Response Score outperformed the Alvarado score. It holds promise to be incorporated into the clinician's daily inventory in efficiently diagnosing Appendicitis.

Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms, and liver PEComas are extremely rare. They are usually discovered incidentally, and diagnostic pitfalls are frequent owing to similar imaging characteristics to other liver neoplasms. We present a patient whose evaluation was consistent with a right-sided hepatocellular carcinoma for which right hepatectomy was performed. Based on the final histopathological examination and immunohistochemistry, a diagnosis of PEComa was made. Immunohistochemistry plays a crucial role in arriving at the diagnosis, and resection represents the standard of care. A long-term follow-up is recommended because the natural history of PEComas is unpredictable.

Dorsal agenesis of the pancreas is a very rare congenital anomaly with less than 100 cases reported in the world literature till 2020. Dorsal agenesis associated with pancreatic tumors is extremely rare; only 17 cases have been reported to date. Here we reported a rare case of dorsal agenesis of the pancreas associated with mixed carcinoma of the pancreas.