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BACKGROUND Acute appendicitis is one of the most common cause of abdominal surgical emergencies. The diagnosis of acute appendicitis is clinical. Despite its frequency, the diagnosis of appendicitis is sometimes difficult. Early diagnosis and prompt operative intervention is the key for successful management of acute appendicitis. In order to reduce the negative appendicectomy rate, various scoring systems have been developed for supporting the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado score and equally its modifications. Aims and Objectives-1. To evaluate the Modified Alvarado Score System (MASS) in the diagnosis of acute appendicitis. 2. To find out sensitivity, positive and negative predictive value of MASS. 3. To find out negative appendicectomy rate. MATERIALS AND METHODSThis is a prospective study conducted in tertiary care teaching hospital in Vidarbha from November 2016 to October 2017. Total 196 patients were evaluated, of which 14 were excluded according to exclusion criteria. Therefore, 182 patients were included in this study. RESULTS182 patients were included in this study. Total 126 (67 males and 59 females) patients were operated. On histopathology, appendicitis was confirmed in 102 (58 males and 44 females) patients. Overall, sensitivity and specificity of Alvarado score was 71.57% and 45.83%. Positive and negative predictive values were found to be 84.88% and 27.5% respectively. Positive appendicectomy rate was found to be 80.95%. Overall, negative appendicectomy rate was 19.05%. CONCLUSIONAcute appendicitis is usually a clinical diagnosis and should remain one in the vast majority of patients coming with right iliac fossa pain. Alvarado scoring system is a very useful method to make a clinical diagnosis of acute appendicitis and can be arrived virtually in no time. KEYWORDS

Introduction - Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology with a multidisciplinary team. Thus, the study to determine the presentation of a patient and further its investigation management and outcome is necessary. Objective: To study all the cases (investigation and outcome) of blunt abdominal trauma with splenic laceration with its incidence , mode of presentation, grade, management and factors responsible for morbidity and mortality. Material and methods: A study was conducted in our tertiary care hospital on 22 patients presented with blunt abdominal trauma with splenic injury in emergency department during July 2019 to June 2021. In our retrospective stu Results: dy , all the patients underwent primary radiological and pathological investigation with 36% having associated limb injuries (fractures);4.5% with ckd , 9% with thoracic injury, 40% amongst 20-40 age group , 86% being male, 59.5% resulted from RTA, 31.5 % resulted from fall from height,0% with assault, 4.5% along with head injury, 9% with associated rib fracture,0% patient with free gas under diaphragm ; 9% with grade 1, 22% with grade 2, 31.5% grade 3 , 13.5% grade 4, 22%grade 5 splenic injuries. 91% patients underwent splenectomy and were given vaccination 15 days post operatively against capsulated organisms.9% patients were managed conservatively. Patients were followed up for 6 months postoperatively with 4.5% mortality rate. Conclusion: Splenic injury is most common solid organ injury in blunt abdominal trauma in 20- 40 years age group majority male and results maximally by RTA; associated with limb fractures commonly with liver as associated solid organ injured. Aggressive resuscitation and emergency laparotomy (splenectomy) yields excellent outcome.