A chronic collection of pancreatic fluid (rich in amylase, lipase and enterokinase) surrounded by a nonepithelialized wall of granulation tissue and fibrosis is referred to as a pseudocyst. Though most frequent loacation is the lesser peritoneal sac, 20% are located at extra pancreatic sites like pleura, mediastinum, pelvis, spleen, liver and perinephric space. Rarely, it can be present as a psoas abscess and this type of presentation is common in middle aged men who are chronic alcoholic. Recent history of pancreatitis may be present. CECT whole abdomen is initial investigation of choice. Presence of high level of amylase and lipase in the aspirate from psoas abscess is confirmatory for the diagnosis.

The incidence of a falciform ligament is very rare. Because of the rarity of the condition and sparsity of available literature, it's very difficult to diagnose this condition preoperatively. In this case, a 65-year-old lady had presented with pain in epigastrium and vomitings for 3 days. All blood investigations were normal except serum Alkaline phosphatase (ALP) and serum gamma-glutamyl transferase (GGT) which were 141 IU/L and 275 U/L respectively. USG revealed only chronic cholecystitis. On diagnostic laparoscopy, falciform ligament abscess was detected which was adequately drained. The patient responded well with the drainage without recurrence till date. Laparoscopic cholecystectomy was also done in the same sitting.

INTRODUCTIONAcute appendicitis is one of the most common surgical emergency with a life time prevalence of approximately 1 in 7.1 Surgery for acute appendicitis is the most frequent operation performed (10% of all emergency abdominal operations) about millions of patients coming annually to emergency worldwide.2 Although abdominal surgeons have been encountering the acute appendicitis for more than 100 years, prompt diagnosis is still elusive in order to reduce morbidity and to avoid serious complications. 3Patients with acute appendicitis often present with characteristic symptoms and physical findings but ABSTRACT Background: Acute appendicitis is the most common abdominal emergency. Although abdominal surgeons have been encountering the acute appendicitis for more than 100 years, prompt diagnosis is still elusive in order to reduce morbidity and to avoid serious complications. Present study was conducted to evaluate the usefulness of Alvarado score in diagnosing acute appendicitis and its role in minimizing the negative appendectomy rate and correlating the same with histopathological findings of appendectomy specimens. Methods: This prospective correlational study was conducted in the Department of General Surgery, Mata Chanan Devi Hospital, New Delhi for a period of one year from January 2014 to December2014.Complete clinical history of the patients was collected in a predesigned proforma. A complete physical and systemic examination was done for all patients. Based on the Alvarado scoring system the patients were divided into three categories. Category 1 (score ranging from 1-4), Category 2 (score ranging from 5-6), Category 3 (score ranging from 7-10). Specimen of removed appendix was sent for histopathological examination and clinically correlated those findings with Alvarado score. Sensitivity, specificity, positive negative likelihood ratios, positive and negative predictive values and negative appendectomy rate were calculated. Results: Out of 100 cases (56 males and 44 females) 15 belonged to category-I, 30 belonged to category-II and 55 belonged to category-III. Surgical procedures were done in 67 patients along with conservative management. Final diagnosis by histopathology was found in 58 cases. The sensitivity and specificity of Alvarado score was found to be 89.66% and 92.86% respectively. PPV and NPV of Alvarado score is 94.55% and 86.67% respectively. The negative appendectomy rate was 13.4%. Conclusions: Alvarado score is a simple non-invasive diagnostic procedure, which is reliable, safe, repeatable and economical, easy and can be used in emergency setting, without expensive and complicated supportive diagnostic tool in diagnosing acute appendicitis and thus still very much relevant in today's modern era with availability of gamut of expensive imaging techniques.

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