A rare diagnosis for a pancreatic mass: splenosis.

Splenosis, the autotransplantation of splenic tissue, has been designed to preserve organ functions after splenectomy. We present the first case of laparoscopic resection of a pancreatic splenosis, in a patient who had undergone a splenectomy 31 years before, complaining of abdominal pain and diarrhea. Abdominal computed tomography (CT) scan showed an enhancing hypervascular 3-cm solid mass in the body of the pancreas, mimicking a pancreatic cancer or a neuroendocrine tumor. A diagnostic laparoscopy was planned, and a 3-cm peripancreatic nodule with a long pedicle was visualized, with many nodules close to the tail of the pancreas and in the greater omentum. They were all resected, and the specimens obtained were immediately sent for frozen-section examination, which confirmed the diagnosis of heterotopic splenic tissue. Splenosis should be included in the differential diagnosis of the pancreatic masses in patients with previous splenic surgery. A hypervascular mass on CT scan should be regarded as an adenocarcinoma of the pancreas until proven otherwise. The possibility of a neuroendocrine tumor mandates an octreotide scan and gastrointestinal hormones dosage. In the unlikely event that all tests may produce equivocal results, a diagnostic laparoscopy is mandatory, in order to obtain an accurate histopathologic diagnosis.

Laparoscopic colorrhaphy, irrigation and drainage in the treatment of complicated acute diverticulitis: initial experience.

The natural history of diverticulosis is worthy of note for its acute, sometimes recurrent, attacks of diverticulitis and the significant risk of serious complications, such as abscess, fistula and peritonitis. Most mild attacks of diverticulitis respond well to medical therapy while surgical treatment is indicated in the complicated forms of the disease. We evaluate the results of treatment of complicated acute diverticulitis by laparoscopic colorrhaphy, irrigation and drainage as a minimal surgical approach in 7 selected patients. We retrospectively analyzed all patients admitted to our institute for acute diverticulitis from 1996 to 2001. One hundred and thirty-five patients were admitted for acute sigmoid diverticulitis. Ninety-eight patients (72%) had their diverticular disease completely resolved after medical therapy, while 37 (28%) required a surgical approach. Seven patients underwent a laparoscopic colorrhaphy with irrigation and drainage. Laparoscopic procedures were completed in 6 patients. No perioperative morbidity or mortality was observed. All patients were discharged with no further re-operation. The technique could be considered a valid alternative for the management of complicated and perforated diverticulitis in selected patients.