The role of laparoscopic appendectomy in complicated appendicitis is still not widely accepted. The authors report their retrospective study performed to evaluate the effectiveness of the laparoscopic approach in the management of complicated appendicitis. From January 2003 to October 2008, 552 patients underwent appendectomy in our surgical department. Among these, 358 were not complicated appendicitis while 194 were complicated. Of the 194 cases of complicated appendicitis, 121 patients underwent laparoscopic appendectomy while the remaining 73 cases were treated by conventional open surgery. The average length of hospital stay was 5.7 days, with a range from 4 to 13 days. Post-operative complications were observed in a total 11 patients (9.1%), including 3 cases of intra abdominal abscess (2.5%), 2 cases of umbilical wound infection (1.6%) and 6 cases of prolonged ileus (4.9%). Our experience suggests that the laparoscopic procedure is a valid, safe and feasible option to manage acute complicated appendicitis.

The anastomotic leakage is one of the most serious complications following colorectal surgery. The incidence rate is between 3% and 21% considering the different experiences, pathology and surgical techniques. Our aim is to verify the role of radiological study in 45 patients with clinical and subclinical colorectal anastomotic leakage total anastomoses = 252). In 31 patients at risk, the operation was concluded with a loop ileostomy. The radiological study gastrografin enema was performed in all patients (26 symptomatic and 19 asymptomatic patients with loop ileostomy). The dehiscence incidence resulted 5.5%: 14 of 252 patients. In our experience the radiological study of selected colorectal anastomoses allowed to show the site and the flow of the leakage and to plan the proper management. In asymptomatic patients the study allowed to programme a specific follow up in patients with higher risk of postinflammatory stenosis or perhaps neoplastic relapse.

Acute right lower abdominal pain is often clinically difficult to diagnose. The diagnosis, especially in young patients, is frequently oriented to appendicular disease. Surgical exploration only confirms diagnosis or surprises the surgeon, revealing an unexpected right colon diverticulitis. This emergency condition challenges the surgeon with the dilemma about the best therapeutic choice: conservative or radical treatment? The elective localization of diverticulitis to the right colon is very rare (6.6-14%). The authors report a case of covered perforation of a solitary cecal diverticulum.