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Despite what is commonly believed, the diagnosis of acute appendicitis is not always easy. Proof of this is the high rate of negative appendicectomies performed yearly in any surgery unit. "Unnecessary" operations involve a huge waste of resources and are sometimes associated with severe complications. In an attempt to obtain a more accurate diagnosis many authors recommend the routine use of sophisticated investigations, which are not always non-invasive and sometimes fail to yield encouraging results. The aim of this study was to retrospectively analyse a group of patients with suspected appendicitis and establish whether certain clinical and instrumental parameters may improve the surgeon's management of such cases and reduce the misdiagnosis rate. Our false-positive rate is in line with those of other studies conducted with the routine use of advanced diagnostic tests without any waste of financial resources or increase in time to diagnosis. These data suggest the superiority of traditional guidelines, based on a careful clinical diagnosis and on common laboratory examinations and ultrasonography, while advanced investigations should be reserved for diagnosing the few ambiguous cases, which are generally confined to more elderly patients.

Congenital deficiency or acquired laxity of the suspensory ligaments, that usually hold the spleen in place in its compartment, may result in extreme splenic mobility. Consequently, this mobility predisposes to torsion of the elongated splenic vascular pedicle creating a situation of acute abdomen due to haemorrhagic infarction. Various imaging modalities for diagnosing the wandering spleen such as ultrasonography, CT scan, MR-angiography, nuclear scan and arteriography are of great value both in the asymptomatic condition and in acute abdomen. We report on an unusual case of wandering spleen with torsion of the pedicle in a middle-aged woman which we casually diagnosed intraoperatively. It was not possible to preserve the wandering spleen by means of splenopexy because the splenic infarction required a splenectomy. Though the condition was not diagnosed prior to surgery, prompt intervention enabled the prognosis to remain unvaried. We review the cases reported in the literature and discuss the diagnostic and therapeutic problems raised by this rare condition.

Carcinoma of the body and tail of the pancreas still remains the disease form with the worst prognosis and evolution. In spite of a huge improvement in diagnostic methods, anaesthetic and surgical procedures and pre- and postoperative assistance, the results in terms of early diagnosis and long-term survival have been generally disappointing. The authors describe their own experience regarding three such tumours treated in five years, analysing the literature data, and referring to the current guidelines in diagnostics and surgical therapy. They then go on to propose a step-by-step approach to the management of these patients. The difficulty of obtaining an early diagnosis of the disease which derives from many factors, such as unspecific and late appearing symptoms, is stressed. They conclude by confirming the need to perform a radical resection, if possible, which, together with a combination of radio- and chemotherapy, is the only procedure capable of holding out some hope of a cure.

Taking as their starting point a case of greater omental torsion recently observed in their surgical department, the authors carefully review the topic and the relevant literature data. This is a rare condition, which though presenting diagnostic difficulties which make it hard to identify preoperatively, poses no problems of a therapeutic nature.