[Histoire d'une rate errante: un case rare d'abdomen aigu]

We present the case of a 17-yearold patient known to have an asymptomatic ectopic spleen, who presented with an acute abdomen. Clinical symptoms and ultrasound led to suspect an acute appendicitis, confirmed later on by pathology. Twenty-four hours after the appendectomy, the patient complained of an abdominal pain of acute onset. Torsion of the pedicle of the ectopic spleen was suspected. Imaging studies supported this diagnosis, and an urgent splenectomy was performed. Did the torsion happen by simple coincidence 24 hours after appendectomy, knowing that the spleen has been asymptomatic for 17 years, or was it precipitated by the surgical intervention ? Should we have removed the ectopic spleen during the appendectomy ? This is the first report of a case of torsion of a wandering spleen after a laparotomy ; a review of the literature is done in order to explain the physiopathology of the disease, and to propose its management

[Insertion des chambres a catheter implantables sous guidage echographique et scopique. Etude prospective portant sur 120 cas]

We compare our results of a prospective study, on 120 totally implantable venous access ports [TIVAP] inserted at angiographic unit, under ultrasound and fluoroscopic guidance, with those of the literature. The 120 AP data, placed under ultrasound and fluoroscopic control for chemotherapy treatment, were prospectively analyzed. The detailed technique of insertion is noted. Data related to the technical success rate and to complications were classified into major, minor, early or late, according to the recommendations of the interventional radiology society. The technical success rate is 100% with no major complication noted. Eight [6.6%] TIVAP were withdrawn because of infection in 4 cases [3.3%], and end of treatment in the other four. The withdrawals took place in chemotherapy clinics. Three [2.5%] are classified as early infections, within two months of the procedure, two of which were associated to wound non-healing. Four patients [3.3%] presented early minor complications [hematoma surrounding TIVAP insertion site]. Our results correspond to previously published data. The insertion of AP at the angiographic unit under ultrasound and fluoroscopic control has lower risk of complications and a success rate higher than that being inserted following anatomical location. Collaboration with a specialized care nurses team is of paramount importance