Middle Segment Pancreatectomy: A Useful Tool in the Management of Pancreatic Neoplasms

Small, benign, or low-grade malignant tumors located in the neck of the pancreas are usually treated with enucleation. However, if enucleation is too risky because of possible damage of the main pancreatic duct, standard pancreatic resections are performed. Such operations can lead to impaired long-term exocrine–endocrine function. Middle segment pancreatectomy consists of a limited resection of the midportion of the pancreas and can be performed in selected patients affected by tumors of the pancreatic neck. Middle segment pancreatectomy is a safe and feasible procedure for treating tumors of the pancreatic neck; in experienced hands it is associated with no mortality but with high morbidity, even if the rate of “clinical” pancreatic fistula is about 20%. Moreover, it allows a surgeon to preserve pancreatic parenchyma and consequently long-term endocrine and exocrine pancreatic function

Splenectomy in severe haemophilia

The management of any surgical condition in a haemophilia patient is a challenging problem for the surgeon. It is particularly difficult if the patient presents in extremis, with no apparent cause for their collapse. We report a case of successful management of spontaneous splenic rupture in a severe haemophiliac, and review the literature associated with this unusual condition.Caldicott, David; Bonnin, Robert; Lloyd, John; Day, Pete