This case illustrates the need for complete removal of both gallbladders during initial surgery. Precise intraoperative recognition of vascular and biliary anatomy-including abnormalities-is highlighted to avoid mistakes during surgery.

In cases of clinically suspected acute appendicitis, the rate of negative laparoscopic exploration ranges from 8 to 15%. In that situation, should we remove an apparently normal appendix or should we leave it in place? If there is no evidence of another cause to explain the acute right iliac fossa pain, it seems reasonable to proceed with an appendicectomy even if the appendix looks normal, because the rate of re-operation for recurrent symptoms is up to 6% and an endo-appendicitis which is defined as inflammation of the appendicular mucosa can be present in 11% to 26% of the cases. Anyway, the therapeutic decision is also influenced by the discussion between the physician and the patient before operation as well as by his past medical history. Good information about the risks and advantages of removal and nonremoval of an apparently normal appendix must be given.

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We present the case of a 71 years old woman who came at the emergency room for abdominal pain and symptoms of occlusion. The scanner demonstrated a colonic occlusion resulting from an incarceration, diagnosed as a hernia of Bochdalek. But two old rib fractures and a past history of a fall directed us to the diagnostic of delayed diaphragmatic rupture. The patient was operated in emergency and post-operative follow-up was simple. Traumatic diaphragmatic hernias are rarely diagnosed directly after trauma. Complications such as pneumonia, occlusion, enteric ischemia, visceral perforation and twisting of splenic hilium can occur many years after the trauma. This is why, for patients with intestinal obstruction or association of pulmonary abdominal symptoms and history of thoraco-abdominal injury, the diagnostic of diaphragmatic hernia should be considered. When patients present complications, there is a higher rate of morbidity and mortality (31%) reason why, emergency surgery is mandatory.