[Preoperative selective embolization allowing a partial splenectomy for splenic hamartoma]. / Embolisation préopératoire sélective permettant une splénectomie partielle pour hamartome splénique.

PURPOSE OF THE STUDY: To underline value of the preoperative splenic embolization with haemostatic aim to facilitate partial splenectomy. MATERIAL: Observation of a 23-year-old woman, admitted for pain, anemia, and mass of the left hypochondrium. Sonography, helical CT and MRI showed that the bulky mass was developed from the upper pole of spleen, and dislodged the left kidney towards the pelvis. This mass had fibrous characteristics in favour of a primary lesion with recent bleeding and was compatible with a splenic hamartoma. METHODS: Selective partial splenic embolization with haemostatic aim using metal coils, immediately followed by surgery. RESULTS: Preoperative embolisation made possible to carry out under optimal surgical conditions a partial splenectomy with en-bloc resection of the splenic mass. Histologic diagnosis was splenic hamartoma of pulpar type. CONCLUSION: This case illustrates the interest of accurate characterization of splenic lesions by several imaging techniques allowing indication for conservative surgery, and of preoperative embolization facilitating a partial splenectomy.

Management of complicated duodenal diverticula.

The duodenum is the second most common location of intestinal diverticula after the colon. Duodenal diverticulum (DD) is usually located in the second portion of the duodenum (D2), close to the papilla. Most duodenal diverticula are extraluminal and acquired rather than congenital; more rare is the congenital, intraluminal diverticulum. DD is usually asymptomatic and discovered incidentally, but can become symptomatic in 1% to 5% of cases when complicated by gastroduodenal, biliary and/or pancreatic obstruction, by perforation or by hemorrhage. Endoscopic treatment is the most common first-line treatment for biliopancreatic complications caused by juxtapapillary diverticula and also for bleeding. Conservative treatment of perforated DD based on fasting and broad-spectrum antibiotics may be offered in some selected cases when diagnosis is made early in stable patients, or in elderly patients with comorbidities who are poor operative candidates. Surgical treatment is currently reserved for failure of endoscopic or conservative treatment. The main postoperative complication of diverticulectomy is duodenal leak or fistula, which carries up to a 30% mortality rate.