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The treatment of the acute diverticulitis is still a stimulating and complex problem sustained by several anatomopathological and clinical factors and the possibility of different therapeutic options, being the operative mortality among 5% and 45%. With the modern technologies it is possible to follow the evolution of the illness so to perform more appropriate therapeutic plan. From 1997 to 2007 we have observed 278 patients with acute diverticulitis. In 219 (78,7%) patients the inflammatory and sub-occlusive condition has been faced with medical therapy, with resolution of the disease in 170 (61%) cases. In 49 (17,6%) patients we have gotten the resolution of the inflammatory disease, but not of the sub-occlusion and therefore we liked to submit them to surgical treatment in election. In 1 case we have found a colovesical fistula. A total of 59 (21,2%) patients with signs of acute abdomen have been submitted to surgery in urgency, within the 24 hours from the hospitalization. We have performed a primary resection with anastomosis and without stoma in all the patients, except in 3 cases in which we have done the Hartmann procedure for the cheap general conditions. We have not recorded intra and postoperative mortality and only in 3 cases we have had a leakage, that has not needed a surgical treatment. In 9 cases we observed infection of the wound, treated with antibiotic therapy. In our experience, performing a surgical procedure, without derivative stoma and manual anastomosis, it seems to be the fittest and less expensive procedure, also in situation of emergency-urgency, without increase of mortality and morbidity.

From 1985 to 2004, 229 patients (171 M, 58 F) aged from 16 to 35 years, affected by pilonidal sinus were treated by complete excision of the sinus and primary closure. Primary healing was achieved in 208 patients (91%) in an average time of 11.9 days. Secondary healing was achieved in 21 patients (9%) in 16-19 days. The mean postoperative hospital stay was 1.9 days and the average time off work 16 days. Recurrent pilonidal sinus was observed in 10 patients with a mean follow-up of 18 months (range: 12-24). On the basis of their experience, the authors conclude that complete excision of the pilonidal sinus with primary closure yields good results in terms of healing, morbidity, early return to work and recurrence rate and can be considered the treatment of choice for pilonidal sinus.

The management of traumatic retroperitoneal haematomas is still a much debated question. Although the diagnosis has become easier using CT with contrast medium, the therapeutic decisions are still difficult because of the great variability of the lesions, which may be simple but very often complicated. Our study is based on 1086 treated patients, 29.5% of the 3682 critical abdominal polytrauma seen in 35 years. Mortality has been 12.9% with a medium ISS (Injury Severity Score) of 23.4. 71.4% of the cases were closed traumas, 28,6% were open traumas. The most common single lesions have been pelvic (43%), followed by the renal traumas (39%). Regarding the associated lesions, the thoracic traumas cause an increment of the ISS score up to 26.2% and of mortality up to 14.6%. The maxillofacial traumas associated with traumatic retroperitoneal haematomas represent 11%, mainly associated with motorcycle accidents, which have increased in the last years from 2,4% in the 70s to 32% these days. Our approach to these patients has been basically conservative. Following the indications obtained by the CT, we widely used interventional angiography, especially for renal lesions and, after pelvic stabilization, for pelvic haematomas. We have chosen surgery considering the kind of traumas (open or closed), the location of the haematoma and especially, the clinical course of the patient's hemodynamic condition.

Authors report their initial experience in surgical treatment of thyroid diseases in an area with high percentage of thyroid tumors. Since January 2006, we examinated 428 patients. By clinical features, hormonal profile, imaging and US-guided FNAB, we selected 134 of them for surgery; 93 patients underwent thyroidectomy in January-November 2006. The Authors analyse therapeutic choises and surgical techniques, stressing the high percentage of thyroid neoplasms.

The abdominal compartment syndrome (ACS) is defined a situation of high degrade abdominal hypertension (IAH) with clinicals signs of multiorganic dysfunction. It's observed like in the intensive care, in particular surgycals and postraumatics, there is ever a bigger frequence of complications presented by criticals patients. The various trials remark a changeable incidence, but the common factor is characterized by a particular severity of scores. All the possibles mechanicals, haemorragicals, infiammatories, and postraumatics causes act, but don't enable the stability among abdominal content, abdominal compliance and parietal tension. The initial triad of effects is constitued by the elevation of diaphragm and the visceral and vascular compression; after this triad provoke a pathophysiologic system that, through various levels, bring to a respiratory, renal and cardiocirculatory dysfunction and to a parietal, hepatic and intestinal ischemia with consequent bacterical translation: sepsis and MOF. The Burch's classification (1996) report four levels of gravity by the slight (< 15 mmHg) to the heavyest (> 35 mmHg): the firsts two levels are of intensivistic competence and for the detention are used conservatives metodics and pharmacological approach; instead in the lasts two levels it's necessary to foresee a surgycal treatment of laparotomy, washing and drainage with following temporary paret's closure. The mortality is now very elevated (29-62%) especially when it's already established a multiorganical dysfunction; therefore it's necessary forward its appearance through the monitorization of abdominal pression (IAP) with the measurement of vescical pression in alls criticals patients at the aim to treat immediately the firsts signs of IAH.

The femoral hernia can be defined as infrequent, and predominantly found in females, with the highest incidence between 30 and 40 years of age. It shows a high tendency to strangulation, also up to 40% of cases, due to the presence of the Gimbernat ligament, which with its tense fibrous margins, aids strangling known as "raised crest". The diagnosis may not be easy, overall in the clinical presence of acute abdomen in elderly patients, disabled people or people who are uncooperative during physical examination. Therefore, it should be sought with an adequate bilateral exploration of the region in all occlused patients and especially with the use of radiological images of the small intestine. The solution currently practiced is prosthetic, proposed by Lichtenstein, and variously modified by Gilbert, Rutkow, Bendavid, and other which uses a prolene plug in the shape of a cigar, umbrella, or basket, according to the size and characteristics of the parietal defect. In emergency conditions, the technique doesn?t change; but if there is stercorary contamination, it is advisable to use direct repair according to the old method of Bassini. In the last 10 years, we have treated 37 femoral hernias in emergency, using direct repair in only 2 cases. In 3 cases we used PTFE; in the other 32 cases prolene was always used; 20 patients were operated under local anesthetic, 12 under general anesthetic and 5 under peridural anesthetic. Satisfactory results were achieved, with average hospital recovery time of 1.4 days, with an early recovery between 3 and 5 days, with only 2 relapses.

Bezoars are masses of indigestible material which form in the stomach. Their genesis depends on the kind of food ingested, on the presence of anomalies of the small bowel and on psychiatric disturbs. Phytobezoar rarely causes bowel obstruction and its most frequent location is the ileocecal valve. The risk increases in those patients who have undergone gastric surgery or present a reduced masticatory ability. Moreover, the genesis can be also caused by endocrine disorders.

Colorectal cancers have an extremely negative prognosis in the elderly, with a high percentage of clinical presentations requiring emergency surgery and high perioperative mortality rates. The clinical manifestations of this type of cancer set in a cutely in 20% of cases due to the sudden onset of one of the basic complications. The authors report on their experience with 79 patients undergoing emergency surgery for colorectal cancer. The choice of operation was made on the basis of the patient's general condition, as estimated by his or her ASA score, and the presence of associated diseases.

Drugs are commonly considered a rare cause of acute pancreatitis but there are an increasing number of reports of numerous medications that seem to be involved in the pathogenesis of acute pancreatitis with different degrees of causative relationship to the disease (definite--probable--possible). The number of drugs that have been associated to date with acute pancreatitis exceeds 260. The authors report here on their personal series of four cases of drug-induced acute pancreatitis (warfarin, lysinopril/hydrochlorothiazide, lamivudine/stavudine/indinavir, valproic acid), focusing on a number of epidemiological and clinical aspects.

Acute pancreatitis in patients with HIV infection is infrequent and often not recognized. Autopsies performed on patients died for different pathologies show pancreatic lesions approximately in 50% of cases. The etiological factors associated with acute pancreatitis are related to HIV infection and particularly to drugs used to treat the syndrome or to prevent opportunistic infections. We report a case in a 38 years old male patient with AIDS without risk factors for acute pancreatitis in which the disease developed while taking Stavudine, Lamivudine and Indinavir. His conditions improved with intensive medical therapy. The subsequent medical course became complicated. The patient died after 75 days for severe abdominal haemorrhage. A review of the literature reports several cases of A.P. in HIV patients mainly related to opportunistic infections. Many authors regard the medical treatment of HIV syndrome as etiological factor but a casual relationship was never demonstrated. The aim of the present paper is to underline that besides Lamivudine also Stavudine and Indinavir might be related to acute pancreatitis. Clinical and laboratory investigations in HIV patients are therefore indicated for an earlier diagnosis and treatment.