[Carcinoid of the minor duodenal papilla associated with multiple jejunal leiomyomas in type 1 neurofibromatosis]. / Carcinoidul papilei duodenale mici asociat cu leiomioame jejunale multiple si neurofibromatoza tip 1.

Duodenal endocrine tumors are rare and represent 2% of all gastrointestinal endocrine neoplasms. Carcinoids of the ampulla of Vater are the most rare primary ampullary tumors. There was noted a frequent association of the endocrine tumors with type 1 neurofibromatosis also known as von Recklinghausen disease. To the best of our knowledge there are only 8 cases of papilla duodenalis minor carcinoids described in the literature. Authors describe herein the first carcinoid of papilla duodenalis minor case associated with multiple synchronic jejunal leiomyomas and von Recklinghausen disease, manifested with proximal intestinal obstruction and resolved by pancreatoduodenectomy (Kausch-Whipple procedure).

[Splenic abscess--etiologic, clinical and diagnostic features]. / Abcesul lienal--aspecte etiologice, clinice si diagnostice.

The aim of the study is to elucidate premorbid grounds, diagnostic and clinical peculiarities, as well as medical and surgical management of non-parasitic spleen abscess. We study 6 cases, with median age 56.7 years, men/women ratio--2:1. Onset-diagnosis period was of median 20 days. In 5 cases (83.3%) spleen abscess developed in immune compromised patients (diabetes mellitus, liver cirrhosis, pancreatitis) and in one case (16.7%) subsequent to blunt abdominal trauma. Clinically, patients presented fever, weight loss and pain in the left upper quadrant of the abdomen. The imaging data (USG, CT, and Rx-thoracic) performed prior to surgery confirmed the diagnosis. USG revealed splenic injury in 80%, CT had a 100% sensibility and thoracic Rx revealed left-side pleuro-pulmonary reaction in 83% of cases. Bacteriological test was positive in 50% of cases. One death was recorded in first 24 hours after surgery. The rest of the cases had a favorable evolution, although, in 2 cases a left subphrenic abscess was noticed, one requiring drainage; in one case--colonic fistula, which closed spontaneously. Although, it's a rare pathology, an early diagnosis is as important, as impossible, and it's delay exhausts the organism and increases the postoperative morbidity rate, splenectomy remaining the safest method of treatment.