Highlights Among the oesophageal tumour, only less than 10% are benign and leiomyoma is the most common tumour representing approximately two-thirds of the cases. Malignant transformation in leiomyomas are rare and cannot be accurately identified with needle aspiration biopsy making resection followed by histopathological evaluation vital. Malignant transformation in leiomyomas is rare and cannot be accurately identified with needle aspiration biopsy making resection followed by histopathological evaluation vital.

Alvarado score is an objective assessment of right lower quadrant pain. Alvarado score is based on sophisticated statistical analysis of symptoms, signs and laboratory data in acute appendicitis. The score ≥ 7 indicates high probability of acute appendicitis. Practically speaking, it is equivalent to one`s degree of clinical suspicion. Therefore this scoring system is used to reach the clinical diagnosis. It is considered that use of the scoring system to make the clinical diagnosis would allow uniformity as more than one senior surgical resident are involved in making the decision. Other studies have shown that Alvarado score has the accuracy of 88%. Graded compression ultrasonography in diagnosis of acute appendicitis has greatly improved the ability to diagnose acute appendicitis with ultrasound. Graded compression sonography plays an important role in reducing the number of negative surgical exploration for acute appendicitis. The accuracy offered by sonography should keep negative laparotomy ratio at approximately 10%.

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A 40 year old female was referred for acute renal failure. Her chief complaints were oliguria and distension of abdomen with lower abdominal pain of three days. In the past, this patient had renal tuberculosis with right sided pyelonephritis (Positive TB polymerase chain reaction qualitative test on urine sample by DNA amplification for Mycobacterium Tuberculosis Complex, MTC ) and right sided hydronephrosis with placement of a double J stent and had taken antituberculosis medication for 6 months. The stent was removed 3 months later. On general examination she was anaemic, her abdomen was distended with flank fullness and there was a fluid thrill. Haematological investigation revealed a haemoglobin of 5.3 g/dl, serum urea-90 mg/dl, and serum creatinine-4.5 mg/dl. She had normal liver biochemistry tests and normal serum electrolytes and carbohydrate antigen (CA-125) was 29.38 U/ml (Normal-0.0-35 U/ml). Urine analysis showed pyuria and bacteriuria and ascitic fluid analysis showed 95% lymphocytosis, however, urine and ascitic fluid were negative for acid fast bacilli. An ultrasound examination showed moderate to gross ascites, gross right hydronephrosis and a thin right renal cortex with mild compensatory hypertrophy of the left kidney, and right adnexal cysts. The urinary bladder was catheterized on admission and treatment commenced for renal tuberculosis with acute renal failure. Gradually her urine output improved to about 2000ml per day. After satisfactory recovery and reduction in her abdominal girth, her urinary catheter was removed. However, in the ensuing days she developed ascitis which required repeated paracentesis. Since no definitive cause of ascitis could be ascertained a