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Acute cholecystitis in the elderly is a severe illness with high operative risks and mortality, which, even if less than in the past, is still too high. The surgical approach has significantly changed over the past 10 years: conservative therapy in the early 1990's was considered the only sure approach, while the laparoscopic surgical approach is recommended today for the emergency treatment of acute cholecystitis, also in the elderly. The aim of this retrospective study was to define the safety and effectiveness of early surgery for acute cholecystitis with the laparoscopic approach in the elderly. From September 2002 to September 2006, 287 patients were admitted to our unit for cholelithiasis, including 135 for acute cholecystitis. The patients with acute illness and age > 70 yrs numbered 73. After immediate monitoring of vital parameters and a brief diagnostic and therapeutic interval to restore the patient's general condition in intensive care (fasting, SNG, antibiotics, parenteral fluid therapy and analgesic drugs) all patients underwent emergency surgery within 24-96 hours. Fifty-nine (80.8%) underwent laparoscopic cholecystectomy, whereas the remaining 14 (19.2%) underwent open cholecystectomy due to their high-risk for cardiovascular, respiratory and metabolic status (ASA III-IV). In group 1 treated laparoscopically, morbidity was 11.9% versus 35.7% in group 2 treated with open cholecystectomy (p < 0.001). Mortality was 0 in group 1; and 7% (1 patient) in group 2 (p < 0.05). The median hospital stay was 3.87 (2-9) days in group 1 vs 10.5 (8-29) days in group 2 (p < 0.001). The results of our study confirm the safety and effectiveness of laparoscopic cholecystectomy in expert hands in the management of acute cholecystitis in elderly patients. This choice allowed a statistically significant reduction in morbidity and overall hospital stay. Nevertheless, open cholecystectomy remains a valuable procedure for high-risk elderly patients undergoing emergency surgery. Poor outcome is related to the almost constant presence of comorbidity in the elderly = ASA score (ASA II vs. IV: p < 0.001) and independent of the type of surgical intervention (laparoscopic cholecystectomy vs open cholecystecotmy: p = n.s.). Early cholecystectomy in case of symptomatic cholelithiasis, before infectious complications set in, could partly reduce the poor prognosis in the elderly.

Hydatidosis is related to parasitical etiology, linked to Echinococcus granulosis and Echinococcus multilocularis. The authors describe an uncommon clinical case of old hydatidosis in an 80-year old woman, presenting hepatic skip , with localization to the right lung and kidney and burrowing to the posterior abdominal wall. Because of the patient's lack of compliance, percutaneous treatment with alcohol of the lumbar lesion with 95% ethanol is carried out under echographic guide, to improve quoad valetudinem prognosis. The authors indicate that the method target are: 1) multiple relapse lesions; 2) complicated anatomie area; 3) multiltle cyst; 4) marginal lesions. Moreover, this method shows important advantages such as be possibility of repetition, low invasivity, high patient's compliance, low rate of shock and dissemination and finally low cost.