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INTRODUCTIONThe acute abdomen is one of the commonest causes of admission to the emergency surgical department. Acute abdomen is a condition of acute abdominal pain, vomiting and bowel complaints of less than 24 hour duration where it becomes mandatory for the treating physician to establish correct diagnosis and perform urgent surgery if the diagnosis is of operative cause. The correct interpretation of abdominal pain is one of the most challenging demand to any surgeon.1 It is of utmost importance to integrate the results of diagnostic investigations with the clinical findings in order to establish the diagnosis. 2-4 METHODSThe data collection was done from 105 cases of nontraumatic acute abdomen adult patients admitted to the emergency surgery department of the tertiary hospital and subsequently operated. The observations were tabulated and inferences drawn. Inclusion criteria Operated patients 13-80 age group acute abdomen cases  Operated non-traumatic acute abdomen cases. ABSTRACTBackground: A prospective observational study of 105 operated cases of non-traumatic acute abdomen in emergency setting in tertiary government hospital was carried out. The correlation between preoperative diagnostic, radiological and clinical assessment and operative findings was noted. The clinical and radiological diagnostic accuracy rates were calculated using descriptive statistical analysis. Negative laparotomy rates were calculated and compared to the previous studies. Methods: The most common finding was acute appendicitis and the most frequently involved age group was 21-40.The absence of correlation between preoperative diagnosis and operative findings was noted in 7 cases of which 2 cases of appendicitis had been missed on ultrasound and 2 cases of appendicular mass were reported as acute appendicitis where appendectomy could not be done on account of adhesions.2 cases of x-ray diagnosed obstruction with clinical features of vomiting ,constipation had no gross bowel pathology on laparotomy while one case diagnosed preoperatively as appendicitis turned out to be a case of renal colic with hydroureter. Results: The diagnostic accuracy rate of x-ray and ultrasound for obstruction/perforation and acute appendicitis were found to be 89.79% and 94.64% respectively. Conclusions: The negative laparotomy rates were low around 2.85%.

Background Appendicitis following trauma is a well-documented sequela of blunt trauma to the abdomen, while appendiceal transection following trauma is extremely rare. Literature reports have documented appendicitis and appendiceal transection as the presenting pathology in a trauma setting. This is first report of auto-amputation of the appendix as a delayed presentation with peritonitis, which was detected during the second surgery in a child with blunt abdominal trauma. Case presentation A 11-year-old Asian boy presented to our center with a 2-day history of blunt abdominal trauma and chief complaint of severe abdominal pain. On evaluation, a computed tomography scan showed gross pneumoperitoneum. The child underwent emergency laparotomy, where a jejunal perforation was noted, which was repaired. The rest of the bowel and solid organs were healthy. The child was managed in the intensive care unit postoperatively, when he developed a burst abdomen. During the second surgery, pyoperitoneum and free-floating appendix were found in the left paracolic gutter. After peritoneal wash, the bowel was noted to be healthy and the previous jejunal repair was intact. The child was allowed oral intake of food and discharged on postoperative days 4 and 8, respectively. At the 1-year follow-up, he remained asymptomatic. Conclusions This case report is unique as it describes auto-amputation of the appendix as a delayed event in the course of treatment for blunt trauma of the abdomen. Although a remote event, the possibility of amputation of the appendix should be retained as a differential diagnosis and unusual complication in cases of delayed peritonitis.

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