BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifi cally for Asian populations. The aim of this study was to compare the modifi ed Alvarado with the RIPASA scoring system in Kuwait population. METHODS:This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS:A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modifi ed Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specifi city of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specifi city. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modifi ed Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signifi cantly, from 18.4% to 10.7% for the modifi ed Alvarado, and to 2.2% for the RIPASA scoring system, which was a signifi cant difference (P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specifi city than the modifi ed Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modifi ed Alvarado scoring system for Kuwait population.

Acute appendicitis is the most common surgical condition with which patients present in emergency departments worldwide. It is also a rare cause of intestinal obstruction. Here, we report a case of a 53-year-old man who presented with a clinical picture of mechanical small bowel obstruction. Leucocytosis was not demonstrated on the routine blood investigation in our case, in contrast to the findings for most patients with acute appendicitis. Acute appendicitis, as the cause of the intestinal obstruction, was diagnosed by computed tomography of the abdomen. The patient was treated using diagnostic laparoscopy and laparoscopic appendectomy. This case was compared with those previously reported in the medical literature to determine the frequency of the case and the surgical management.

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Periampullary cancers are a group of tumours with similarities in symptoms and treatment, the prognoses of which are better than that of proper ductal pancreatic carcinoma. They are still sometimes diagnosed unexpectedly at operations for other reasons, such as gallstone disease and they are best diagnosed with the triad of duodenoscopy, endoscopic retrograde cholangiopancreatography and endoscopic biopsy, but one should never rely on a negative biopsy. For evaluation of resectability chest X-ray, ultrasonography and angio-CT currently are recommended for routine use and patients with resectable tumours should be offered a Whipple operation unless their general condition and/or tumour stage contradict attempted curative surgery. Long-term survival is gratifying after resection of tumours originating in the papilla, ampulla and bile duct. This is also true for those high-risk, fragile patients undergoing local excision of the tumour with free resection margins. The obstructive jaundice in patients who are pre-operatively deemed to have incurable disease or in the very frail and old patients is preferably relieved endoscopically. In those selected for laparotomy but in whom the tumour is found to be irresectable surgical biliary bypass nowadays can be done with low hospital mortality and morbidity. We feel that prophylactic gastrojejunostomy should be done selectively. If it is not possible to control pain pharmacologically palliation can often be adequately achieved by a percutaneous coeliac bloc. Additionally, the initial results of thoracoscopic sympathectomy seem promising.

Objectives: A retrospective study of laparoscopic appendectomy (LA) versus open appendectomy (OA) was performed on patients with suspected acute appendicitis. Patients were selected for OA or LA according to the clinical evaluation, and preference of the surgeon. Methods: Over a 2-year period 180 patients were included, of whom 94 patients underwent OA, and 86 patients underwent LA. Results: LA was successfully completed in 76 patients (88.3%). The mean hospital stay in OA was 3.2 days versus 2.7 days in LA. The mean operative time was shorter in OA than in LA (51.6 versus 59.8 min). There was no significant difference in convalescence between both the groups, however, there was a tendency towards less narcotic requirement among the LA group. Postoperative complications in patients who underwent OA included: chest infection (3 patients), wound infection (4 patients), thrombophlebitis (1 patient). Complications after LA included: pelvic collection (1 patient), chest infection (1 patient), ileus (1 patient). There was no wound infection in the LA group. There was no death in either groups. Conclusion: LA is a safe procedure comparable to OA, however, it requires skills in laparoscopy and prospective randomized trials are needed to confirm its advantages over conventional appendectomy.